Trial of self-expandable metallic stents in the palliation of tracheo-oesophageal fistula in carcinoma of the oesophagus
Subjects. Fifty-eight patients with cancer of the oesophagus were studied from July 2002 to November 2005. Thirty-seven patients presented with strictures and 21 presented with tracheo-oesophageal fistula (TOF). Methods. There were 35 males and 23 females. Mean age was 57 years. Stents were positioned under fluoroscopic guidance, in the majority of cases under conscious sedation. A contrast study was done on day 1 to assess stent expansion and sealing of the TOF. Data were analysed using Stata Statistcal Software, Release 8.0. Survival was calculated using Kaplan-Meier methodology and log-rank tests were used to assess differences. A p-value < 0.05 was considered to be statistically significant. Results. Stenting was successful in 57 of the 58 patients; 1 perforation occurred at the time of insertion. In total, 68 stents were inserted in 58 patients. Re-stenting was necessary in 10 patients, because of tumour overgrowth (N = 5), stent migration (N = 3) and recurrent fistula (N = 2). Dysphagia improved from a mean score of 2.98 to 1.08. All lesions were squamous cell carcinoma. The positions of the fistulas were proximal (N = 4), middle (N = 14) and distal (N = 3). Over half of the patients in the TOF group had concomitant pneumonia at presentation with decreased survival (p = 0.010) and a hazard ratio of 10.86. Two patients died, on days 4 and 7 respectively. Median survival was 91 days (range 0 - 273 days) for the stricture group and 62 days (range 3 - 413 days) for the TOF group, but these differences were not significant (p = 0.945). Conclusion. Covered self-expandable metallic stents provide an acceptable option for the palliation of TOF due to cancer of the oesophagus.
South African Journal of Surgery Vol. 45 (1) 2007: pp. 24-27