Methods: Esophageal self-expandable metal stents were deployed in 56 patients (55 males, 1 female; mean age 63.5 years; range, 42 to 79 years) with malignant dysphagia due to lung cancer between August 2002 and May 2018. Of the patients, 34 had received previous chemoradiotherapy, eight only chemotherapy, and three only radiotherapy, while four had pneumonectomy. Tracheoesophageal fistula was coexisting in 12 patients (21%). Stents were inserted under fluoroscopic control over guide-wire in 28 patients and under flexible endoscopic control in the remaining 28 patients. One stent was used in all patients, except two patients with tracheoesophageal fistula, one patient who had an external compression causing downward migration of stent, and two patients who had tumor progression.
Results: Dysphagia improved in all patients after stent insertion. Tracheoesophageal fistula was sealed off in all patients. All patients remained asymptomatic without dysphagia symptoms during the follow-up period except for two patients who underwent gastrostomy. All patients with tracheoesophageal fistula died. Their mean duration of survival was 2.8 months. Of the patients with tracheoesophageal fistula, one died of mediastinitis, one died of esophageal perforation, while the others died of cancer-related reasons. Of the dysphagia patients without tracheoesophageal fistula, all died except for two patients. Mean duration of survival in this group was 4.3 months.
Conclusion: Dysphagia in lung cancer may have many underlying reasons. Self-expandable metal stents may provide satisfactory relief of dysphagia symptoms with minimal morbidity after a single procedure in patients with limited lifespan.
Statistical analysis
Statistical analysis was performed using the IBM
SPSS version 20.0 (IBM Corp., Armonk, NY, USA). Data were expressed as mean±standard deviation.
Frequencies and percentages were used for the
categorical measures.
As several studies reported that prior radiotherapy increased the risk of severe complications after SEMS placement, we also think that SEMS provides more efficient nutrition in patients with planned radiotherapy with minimal complication rate.[17,18] The considerable length of survival in patients with TEF should encourage palliative treatment of dysphagia in patients with advanced lung cancer to allow improved oral nutrition and quality of life. Although survival durations of patients with TEF are much shorter, SEMS application prevents early death from pulmonary sepsis. Dubecz et al.[19] suggested that patients with advanced lung cancer had a median survival of 48 days, while patients with TEF had a median survival of 58 days. In our study, duration of survival was shorter in patients with TEF (mean 2.8 months for TEF and 4.3 months for non-TEF), with 54% of patients surviving less than one month.
Our study has some limitations. First, it is a retrospective study including consecutive patients; thus, the study is open to selection bias. Secondly, our findings are from a single institution and a small sample size due to the rarity of the entity. Despite these limitations, the current study provides valuable information about the standard procedure for the insertion of SEMS in all patients and evaluates this perfect palliative method from many perspectives.
In conclusion, dysphagia in lung cancer may cause numerous secondary problems besides lung disorders. Self-expandable metal stents may provide satisfactory relief of dysphagia with minimal morbidity in a single procedure in patients with limited lifespan.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect to
the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.
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