Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland.
Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Eur J Cardiothorac Surg. 2017 Aug 1;52(2):385-391. doi: 10.1093/ejcts/ezx097.
Previous studies have shown a link between oesophageal stenting before oesophagectomy and worse oncological outcomes. Our objective was to determine the effect of preoperative self-expanding covered metallic stent (SEMS) on survival, progression-free survival (PFS), operative time and complication rates in oesophageal cancer (EC).
This study included EC patients undergoing surgery between January 2006 and January 2014 with a cT2 tumour or higher ( n = 174; 135 adenocarcinomas and 39 squamous cell carcinomas). We propensity matched 1:1 a preoperative SEMS group ( n = 30) to a control group. Despite the propensity matching, statistically non-significant residual covariate imbalances persisted. Median follow-up time was 33 months (range: 0-118 months). We performed Kaplan-Meier survival analysis for OS and PFS, the Student's t -test for operative time and the chi-squared test for complication rates.
Median survival in the SEMS group was 28.5 months (range: 0-116 months) vs 34 months (4-118 months) in the control group and median PFS was 22 months (0-111 months) vs 27 (4-113 months) ( P = 0.748 and P = 0.764, respectively). Mean operative times between groups were 436 min vs 375 min ( P = 0.017). No differences emerged in intraoperative (23.3% vs 10%, P = 0.299), early (50.0% vs 46.7%, P = 1) or late complication rates (53.3% vs 43.3%, P = 0.606).
SEMS application has no significant effect on survival, PFS or complications. Mean operative time was significantly higher in the SEMS insertion group. We therefore conclude that preoperative SEMS insertion makes the operation more challenging by increasing operative time, but is otherwise a feasible and safe strategy in experienced centres as a bridge to surgery.
先前的研究表明，食管切除术前行食管支架置入术与较差的肿瘤学结果之间存在关联。我们的目的是确定术前自膨式覆膜金属支架（SEMS）对食管鳞癌（EC）患者的生存、无进展生存（PFS）、手术时间和并发症发生率的影响。
本研究纳入了 2006 年 1 月至 2014 年 1 月期间接受手术治疗且肿瘤 cT2 或更高（n=174；135 例腺癌和 39 例鳞癌）的 EC 患者。我们采用 1:1 倾向评分匹配（PSM）方法将术前 SEMS 组（n=30）与对照组进行匹配。尽管进行了 PSM，但仍存在统计学上无显著意义的残留协变量不平衡。中位随访时间为 33 个月（范围：0-118 个月）。我们对 OS 和 PFS 进行了 Kaplan-Meier 生存分析，对手术时间进行了 Student's t 检验，对并发症发生率进行了卡方检验。
SEMS 组的中位生存时间为 28.5 个月（范围：0-116 个月），对照组为 34 个月（4-118 个月）；中位 PFS 分别为 22 个月（0-111 个月）和 27 个月（4-113 个月）（P=0.748 和 P=0.764）。两组的平均手术时间分别为 436 分钟和 375 分钟（P=0.017）。术中并发症发生率（23.3%比 10%，P=0.299）、早期并发症发生率（50.0%比 46.7%，P=1）和晚期并发症发生率（53.3%比 43.3%，P=0.606）无差异。
SEMS 应用对生存、PFS 或并发症无显著影响。SEMS 插入组的平均手术时间显著较高。因此，我们认为在经验丰富的中心，术前 SEMS 插入作为手术的桥梁，虽然增加了手术时间，使手术更具挑战性，但仍是一种可行且安全的策略。
