Stents for proximal esophageal cancer: A case-control study

Background: Self-expandable metal stents (SEMSs) are an established palliative therapy for esophageal cancer. SEMS placement for cancers near the upper esophageal sphincter (UES) is controversial because of a perceived increased risk of complications. Objective: To compare outcomes after patients stented for proximal esophageal cancer (PC) and distal esophageal cancer (DC). Design: Matched case-control study from a prospective database. Setting: Tertiary referral center, Tenwek Hospital, Bomet, Kenya. Patients: All patients with PC located within 6 cm of the UES were matched with randomly selected controls with DC. Interventions: Outcomes of PC cases were compared with those of DC controls. Main Outcome Measurements: Dysphagia score, complications, median survival. Results: A total of 151 patients with PC were identified and were randomly matched with DC controls. Ninety-three case-control pairs had adequate follow-up information available. Mean dysphagia scores (scale 0-4) improved from 3.4 and 3.3 before stenting for PC and DC, respectively, to 1.5 after stenting for both groups (P = .93). Early complications occurred in 6.5% of PC cases and 9.7% of DC controls (P = .44). Late complications occurred in 20.4% of PC cases and 15.1% of DC controls (P = .25). Median survival was 210 days for PC cases and 272 days for DC controls (P = .25). Outcomes were similar for the subgroup of PC cases whose cancer extended to within 2 cm of the UES. Limitation: An important limitation is the absence of adequate follow-up data for 58 of the 151 case-control pairs. Conclusions: SEMSs effectively palliate dysphagia in PC cases, whereas complication and survival rates are not statistically different from those of DC controls.