Top

Surgical Endoscopy

Published in:

01-08-2004 | Original article

Endoscopic palliative treatment for esophageal and gastric cancer: techniques, complications, and survival in a population-based cohort of 948 patients

Authors: A. M. Thompson, T. Rapson, F. J. Gilbert, K. G. M. Park

Published in: Surgical Endoscopy | Issue 8/2004

Abstract

Background

Under the auspices of the Scottish Audit of Gastric and Esophageal Cancer, we investigated treatment techniques, complications, and survival in a population-based cohort of patients undergoing endoscopic palliative therapy for esophageal or gastric cancer.

Methods

A total of 948 patients undergoing endoscopic palliative therapy were identified prospectively and followed for a minimum of 1 year.

Results

Expandable metal stent placement (506 patients) and LASER (117 patients) were the most frequently used treatment options. Stent placement was more common for grade 3 or 4 dysphagia. Delivery of endoscopic palliative therapy varied by region of residence (from 18% to 38% of patients, p < 0.001) but not by deprivation category. Complications were recorded in 16% of patients (155 of 948). Overall survival was 40% (95% confidence interval [CI], 36–43) at 6 months, 17% (95% CI, 14–19) at 12 months, and 10% (95% CI, 8–12%) at 18 months.

Conclusions

These data define the reality of endoscopic palliative therapy for patients with advanced esophageal or gastric cancer and provide a baseline against which future improvements in care can be measured.

Acunas, B, Rozanes, I, Akpinar, S, Tunaci, A, Tunaci, M, Acunas, G 1996Palliation of malignant oesophageal strictures with self expanding nitional stents: drawbacks and complicationsRadiology199648652PubMed

Adam, A, Ellul, J, Watkinson, AF, Tan, BS, Morgan, RA, Saunders, MP, Mason, RC 1997Palliation of inoperable oesophageal carcinoma: a prospective randomised trial of LASER therapy and stent placementRadiology202344348PubMed

Bachmann, MO, Alderson, D, Edwards, D, Worron, S, Bedford, C, Peters, TJ, Harvey, IM 2002Cohort study in south and west England of the influence of specialization on the management and outcome of patients with oesophageal and gastric cancersBr J Surg89914922CrossRefPubMed

Brierley, J, Wong, CS, Cummings, B, Catton, P, Ringash, J, Catton, C, McLean, M, et al. 2001Squamous cell carcinoma of the oesophagus treated with radiation and 5-fluorouracil, with and without mitomycin CClin Oncol13157163

Carter, R, Smith, JS, Anderson, JR 1992LASER recanalisation versus endoscopic intubation in the palliation of malignant dysphagia: a randomised prospective studyBr J Surg7911671170PubMed

Caspers, RJ, Welvaart, K, Verkes, RJ, Hermans, J, Leer, JW 1988The effect of radiotherapy on dysphagia and survival in patients with esophageal cancerRadiother Oncol121523PubMed

Coia, LR, Minsky, BD, Berkey, BA, John, MJ, Haller, D, Landry, J, Pisansky, TM, et al. 2000Outcome of patients receiving radiation for cancer of the oesophagus: results of the 1992–1994 patterns of care studyJ Clin Oncol18455462PubMed

Cowling, MG, Hale, H, Grundy, A 1998Management of malignant oesophageal obstruction with self expanding metal stentsBr J Surg85264266CrossRefPubMed

Dallal, HJ, Smith, GD, Grieve, DC, Ghosh, S, Penman, ID, Palmer, KR 2001A randomised trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinomaGastrointest Endosc54549557CrossRefPubMed

10.

Ell, C, May, A 1997Self-expanding stents for palliation of stenosing tumors of the esophagua and cardia: a critical reviewEndoscopy29392398 PubMed

11.

Gillison, EW, Powell, J, McConkey, CC, Spychal, RT 2002Current nature and management of cancer of the oesophagus and cardiaBr J Surg87362373CrossRef

12.

Givers, AM, Macken, E, Hiele, M, Rutgeerts, P 1998A comparison of LASER therapy, plastic stents and expandable metal stents for palliaiton of malignant dysphagia in patients without a fistulaGastrointest Endosc48383388PubMed

13.

Harris, V, Sandridge, AL, Black, RJ, Brewster, DH, Gould, A 1998Cancer Registration Statistics Scotland 1986–1995ISD Scotland PublicationsEdinburgh. Available online at: http://www.show.scot.nhs.uk/publications/isd/cancer-registrationCrossRef

14.

Hayter, CR, Huff-Winters, C, Puszal, L, Youssef, YM, Shelley, WE, Shulze, K 2000A prospective trial of short course radiotherapy and chemotherapy for palliation of dysphagia from advanced esophageal cancerRadiother Oncol56329333CrossRefPubMed

15.

Herskovic, A, Martz, K, al-Sarraf, M, Leichman, L, Brindle, J, Vaitkevicius, V, Cooper, J, et al. 1992Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the oesophagusN Engl J Med32615931598PubMed

16.

Knyrim, K, Wagner, HJ, Bethge, N, Keymling, M, Vakil, N 1993A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancerN Engl J Med32913021307CrossRefPubMed

17.

Ludwig, D, Dehne, A, Burmester, E, Wiedemann, GJ, Stange, EF 1998Treatment of unresectable carcinoma of the oesophagus or the gastroesophageal junction by mesh stents with or without radiochemotherapyInt J Oncol13583588PubMed

18.

Mason, RC, Bright, N, McColl, I 1991Palliation of malignant dysphagia with LASER therapy: predictablility of resultsBr J Surg7813461347PubMed

19.

Mellow, MH, Pinkas, H 1985Endoscopic LASER therapy for malignancies affecting the esophagus and gastroesophageal junction: analysis of technical and functional efficacyArch Int Med14514431446CrossRef

20.

O’Donnell, CA, Fullarton, GM, Watt, E, Lennon, K, Murray, GD, Moss, JG 2002Randomized clinical trial comparing self-expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancerBr J Surg89985992CrossRefPubMed

21.

Pye, JK, Crumplin, MKH, Charles, J, Kerwat, R, Foster, ME, Biffin, A 2001One-year survey of carcinoma of the oesophagus and stomach in WalesBr J Surg88278285CrossRefPubMed

22.

Scottish Cancer Intelligence Unit2000Trends in cancer survival in scotland 1971–1995Information and Statistics DivisionEdinburgh. Available online at: http://www.show.scot.nhs.uk/isd

23.

Shimi, SM 2000Self expanding metallic stents in the management of advanced oesophageal cancer: a reviewSemin Laparosc Surg7921PubMed

24.

Shmueli, E, Myszor, MF, Burke, D, Record, CO, Matthewson, K 1992Limitations of LASER treatment for malignant dysphagiaBr J Surg79778780PubMed

25.

Sihvo, EIT, Pentikainen, T, Luostarinen, ME, Ramo, OJ, Salo, JA 2002Inoperable adenocarcinoma of the oesophagogastric junction: a comparative clinical study of LASER coagulation versus self-expanding metallic stents with special reference to cost analysisEJSO28711715CrossRefPubMed

26.

Thompson, AM (2001) “Oesophageal and gastric cancer” In: Cancer scenarios: an aid to planning cancer services in Scotland in the next decade, The Scottish Executive, Edinburgh. Available online at:www.show.scot.nhs.uk/isd/cancer/cancer.htm

27.

Warren, WH 2000Palliation of dysphagiaChest Surg Clin N Am10605623PubMed

Title: Endoscopic palliative treatment for esophageal and gastric cancer: techniques, complications, and survival in a population-based cohort of 948 patients
Authors: A. M. Thompson
T. Rapson
F. J. Gilbert
K. G. M. Park
Publication date: 01-08-2004
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 8/2004
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-003-9256-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic palliative treatment for esophageal and gastric cancer: techniques, complications, and survival in a population-based cohort of 948 patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2004

Characterizing the “gold standard” image for laparoscopic surgery

Body image after laparoscopic or open donor nephrectomy

The AESOP robot system in laparoscopic surgery: Increased risk or advantage for surgeon and patient?

Laparoscopic navigation pointer for three-dimensional image–guided surgery

Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis

Synchronous bilateral endoscopic adrenalectomy