Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY 40206, USA.
J Am Coll Surg. 2011 Apr;212(4):582-8; discussion 588-9. doi: 10.1016/j.jamcollsurg.2010.12.026.
Many surgeons are reluctant to use esophageal stents during neoadjuvant therapy for esophageal cancer because of concerns about nutritional status, stent-related complications, or added difficulties during esophagogastrectomy. We hypothesized that esophageal stenting during neoadjuvant therapy allows for optimal nutritional intake without adversely affecting perioperative outcomes.
This study is a prospective, dual-institution, single-arm, phase II evaluation of esophageal cancer patients undergoing neoadjuvant therapy before resection. All patients had a self-expanding polymer stent placed before neoadjuvant therapy. We monitored dysphagia symptoms, nutritional status, stent-related complications, and perioperative complications during the course of therapy and 90 days postoperatively.
We enrolled 32 patients with dysphagia and weight loss who were eligible for neoadjuvant therapy. After stent placement, 2 patients had stent migrations requiring replacement. No erosive complications were observed. During the course of neoadjuvant therapy, we noted improvement in dysphagia, mild weight loss, and maintenance of performance status. At a median of 50 days (range 18 to 92 days) after completion of neoadjuvant therapy, 20 patients underwent margin-negative esophagogastrectomy (16 Ivor Lewis, 4 minimally invasive) without problems with stent removal or difficulty in surgical dissection. Twelve patients did not undergo resection due to development of metastases (n = 8) or rapid decline in functional status (n = 4). Major perioperative complications included pulmonary embolism (n = 2), chyle leak (n = 1), and bronchial injury (n = 1). No surgical complications were attributed to stent placement.
Use of esophageal stents during neoadjuvant therapy is safe and results in resolution of dysphagia, mild weight loss, and maintenance of performance status without an effect on intraoperative dissection, perioperative complications, or delay in resection after neoadjuvant therapy.
许多外科医生不愿意在食管癌新辅助治疗期间使用食管支架，因为担心营养状况、支架相关并发症，或在食管胃切除术中增加难度。我们假设在新辅助治疗期间放置食管支架可以实现最佳的营养摄入，而不会对围手术期结果产生不利影响。
这是一项前瞻性、双机构、单臂、二期评估接受新辅助治疗前切除的食管癌患者的研究。所有患者在新辅助治疗前均放置自膨式聚合物支架。我们在治疗过程中和术后 90 天监测吞咽困难症状、营养状况、支架相关并发症和围手术期并发症。
我们共纳入 32 例有吞咽困难和体重减轻症状、适合新辅助治疗的患者。支架放置后，有 2 例支架移位需要更换。未观察到侵蚀性并发症。在新辅助治疗过程中，我们注意到吞咽困难改善、体重轻度减轻和保持功能状态。在新辅助治疗完成后中位数为 50 天（范围 18 至 92 天），20 例患者接受了阴性切缘的食管胃切除术（16 例 Ivor Lewis，4 例微创），支架取出和手术解剖无问题。由于发生转移（n=8）或功能状态迅速下降（n=4），12 例患者未进行切除。主要围手术期并发症包括肺栓塞（n=2）、乳糜漏（n=1）和支气管损伤（n=1）。无手术并发症归因于支架放置。
在新辅助治疗期间使用食管支架是安全的，可缓解吞咽困难、轻度体重减轻和保持功能状态，而不会影响术中解剖、围手术期并发症或新辅助治疗后延迟切除。
