Self-expandable metallic stents for patients with recurrent esophageal carcinoma after failure of primary chemoradiotherapy

Background: Recent advances in chemoradiotherapy for esophageal carcinoma h ave resulted in improved survival rates. However, there are flew options fo r recurrent dysphagia due to refractory carcinoma after failure of primary chemoradiotherapy. The aim of this study was to evaluate the safety and eff icacy of self-expandable metallic stent placement for patients with recurre nt esophageal carcinoma where definitive chemoradiotherapy has failed. Methods: Thirteen consecutive patients with recurrent squamous cell carcino ma of the esophagus, in whom self-expandable metallic stents were placed af ter failure of primary chemoradiotherapy, were studied retrospectively. All patients had esophageal obstruction or malignant fistula. Results: The oral alimentation status of nine of 13 patients (69%) improved after successful placement of the stent. Following placement of the stent, fever (>38 degreesC) and severe chest pain occurred in 85% (11/13) of the patients. In all patients examined, C-reactive protein was elevated within 1 week of the operation. Esophageal perforation occurred in three patients. Stent-related mediastinitis and pneumonia developed in six (46%) and three (23%) patients, respectively. Seven of the 13 patients (54%) died of scent -related pulmonary complications. Conclusion: Although the placement of a self-expandable metallic stent for patients with recurrent esophageal carcinoma after failure of chemoradiothe rapy improved their oral alimentation status, we found that this treatment increases the risk of life-threatening pulmonary complications.