Department of Surgery, Queen Elizabeth Central Hospital, University of Malawi, College of Medicine, Blantyre, Malawi.
J Surg Oncol. 2012 Mar 15;105(4):410-4. doi: 10.1002/jso.23003. Epub 2011 Dec 12.
Esophageal cancer is common in Malawi and most patients are inoperable at time of diagnosis. The aim of this study was to prospectively evaluate palliative treatment with self-expanding metal stents (SEMS) in Malawi, a low-income country with limited medical resources.
Data of patients with advanced inoperable esophageal cancer were prospectively collected. Tumor and patient specifics, risk factors, dysphagia scores, complications, and survival were assessed. Follow-up data for 1 year or until death were collected from 118/143 patients (83%) during clinic visits, home visits, or via cell phone.
One hundred forty-three patients were treated with 154 SEMS. Median survival was 210 days (95% CI: 150-262 days). Fourteen of 118 patients with complete follow-up (11.9%) survived more than 1 year with longest documented survival of 406 days. The median dysphagia score improved from 3 at the time of presentation to 0 at the time of death. Early complications occurred in 4.2% (6/143), late complications in 11.9% of patients (14/118). The procedure related mortality was 2.1% (3/143).
SEMS is an appropriate palliative treatment in a resource-limited environment. For the vast majority of patients a single intervention provides lasting improvement of dysphagia.
食管癌在马拉维很常见，大多数患者在诊断时已无法手术。本研究旨在前瞻性评估自膨式金属支架（SEMS）在马拉维这个医疗资源有限的低收入国家的姑息治疗效果。
前瞻性收集了晚期不可切除食管癌患者的数据。评估了肿瘤和患者特征、危险因素、吞咽困难评分、并发症和生存情况。通过临床就诊、家访或电话联系，对 118/143 例（83%）患者进行了为期 1 年或直至死亡的随访。
143 例患者共接受了 154 个 SEMS 治疗。中位生存时间为 210 天（95%CI：150-262 天）。118 例有完整随访的患者中，14 例（11.9%）存活超过 1 年，最长记录的存活时间为 406 天。在就诊时的吞咽困难评分为 3 分，在死亡时的评分中位数提高到 0 分。早期并发症发生率为 4.2%（6/143），晚期并发症发生率为 11.9%（14/118）。该操作相关死亡率为 2.1%（3/143）。
在资源有限的环境中，SEMS 是一种合适的姑息治疗方法。对于绝大多数患者，单次干预即可持久改善吞咽困难。
