Vinayak Nagaraja1, Michael R Cox1, Guy D Eslick1. 1. The Whiteley-Martin Research Centre, Discipline of Surgery, The Sydney Medical School Nepean, Penrith, New South Wales, Australia.
Abstract
BACKGROUND: Patients with locally advanced esophageal cancer who require neoadjuvant therapy have significant dysphagia and may severely impair nutritional status. We conducted a meta-analysis to assess the efficacy of self-expandable metal stents prior to neoadjuvant therapy. METHODS: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. Original data was abstracted from each study and used to calculate a pooled odd ratio (OR) and 95% confidence interval (95% CI). RESULTS: Only nine studies comprising of 180 patients were included for analysis. The overall procedural success rate was 95% (95% CI, 0.895-0.977). There was a substantial decrease in the dysphagia scores standard difference in means (SDM) -0.81 [standard error (SE) 0.15, 95% CI, -1.1 to -0.51], similar increase in weight SDM 0.591 (SE 0.434, 95% CI, -0.261 to 1.442) and serum albumin SDM 0.35 (SE 0.271, 95% CI, -0.181 to 0.881). The incidence of major adverse events included stent migration 32% (95% CI, 0.258-0.395) and chest discomfort 51.4% (95% CI, 0.206-0.812). CONCLUSIONS: Placement of stents in patients with locally advanced esophageal cancer significantly improves dysphagia and allows for oral nutrition during neoadjuvant therapy. Stents appear to be effective for palliating dysphagia. Stent migration was a common occurrence; however, migration may be a sign of tumor response to neoadjuvant therapy.
BACKGROUND:Patients with locally advanced esophageal cancer who require neoadjuvant therapy have significant dysphagia and may severely impair nutritional status. We conducted a meta-analysis to assess the efficacy of self-expandable metal stents prior to neoadjuvant therapy. METHODS: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. Original data was abstracted from each study and used to calculate a pooled odd ratio (OR) and 95% confidence interval (95% CI). RESULTS: Only nine studies comprising of 180 patients were included for analysis. The overall procedural success rate was 95% (95% CI, 0.895-0.977). There was a substantial decrease in the dysphagia scores standard difference in means (SDM) -0.81 [standard error (SE) 0.15, 95% CI, -1.1 to -0.51], similar increase in weight SDM 0.591 (SE 0.434, 95% CI, -0.261 to 1.442) and serum albumin SDM 0.35 (SE 0.271, 95% CI, -0.181 to 0.881). The incidence of major adverse events included stent migration 32% (95% CI, 0.258-0.395) and chest discomfort 51.4% (95% CI, 0.206-0.812). CONCLUSIONS: Placement of stents in patients with locally advanced esophageal cancer significantly improves dysphagia and allows for oral nutrition during neoadjuvant therapy. Stents appear to be effective for palliating dysphagia. Stent migration was a common occurrence; however, migration may be a sign of tumor response to neoadjuvant therapy.
Entities:
Keywords:
Neoadjuvant therapy; esophageal cancer; self-expandable metal stents
Authors: R B O'Gorman; D V Feliciano; K S Matthews; R Matthews; C G Bitondo; K L Mattox; G L Jordan Journal: Surgery Date: 1986-05 Impact factor: 3.982
Authors: Sean M Stokes; Elliot Wakeam; Mara B Antonoff; Leah M Backhus; Robert A Meguid; David Odell; Thomas K Varghese Journal: J Thorac Dis Date: 2019-03 Impact factor: 2.895
Authors: Abu Bakar Hafeez Bhatti; Farrukh Hassan Rizvi; Anum Waheed; Syed Hassan Raza; Aamir Ali Syed; Shahid Khattak; M Aasim Yusuf Journal: World J Surg Date: 2015-02 Impact factor: 3.352
Authors: Zachary L Smith; Jason E Gonzaga; George B Haasler; Elizabeth M Gore; Kulwinder S Dua Journal: Dig Dis Sci Date: 2017-04-08 Impact factor: 3.199