F-123PREOPERATIVE STENTING IN OESOPHAGEAL CANCER DOES NOT HAVE AN EFFECT FOR SURVIVAL, DISEASE PROGRESSION OR COMPLICATIONS: A PROPENSITY-MATCHED CASE-CONTROL STUDY

Abstract

Objectives: To determine the effect of preoperative self‐expanding covered metallic stent (SEMS) on overall survival (OS), progression free survival (PFS), operative time and complication rates in oesophageal cancer (EC). Methods: All oesophagectomy patients with EC (N = 234) between 2006 and 2013, who had primary tumour cT2 or higher (N = 174) were included (135 adenocarcinoma and 38 squamous cell carcinoma). Preoperative SEMS group (N = 30; adenocarcinoma 23 and squamous cell 7), was propensity‐matched 1:1 to a control group without preoperative SEMS. Median follow‐up was 33 months (range 0‐115 months). Kaplan‐Meier survival analysis was used for OS and PFS, Student's t‐test for operative time and chi‐squared test for complication rates were used. Results: Neoadjuvant chemotherapy was given to 56.7% and chemoradiation to 33.3% of the patients. Minimally invasive oesophagectomy (MIE) was completed in 51.6% and hybrid MIE in 6.7%. Median survival in the SEMS group and control group was 32.5 months (0‐111 months) vs 29.5 months (5‐108 months) and median PFS was 23.5 months (0‐111 months) vs 28.5 (2‐108 months), (P = 0.540 and P = 0.932). Overall survival of SEMS and control group is presented in the Kaplan‐Meier plot (P = 0.540). Mean operative times between the groups were 436 min vs 401 min (P = 0.156). There were no differences in intraoperative (23.3% vs 10%, P = 0.233), early (50.0% vs 43.3%, P = 0.796) or late complications (53.3% vs 30.0%, P = 0.115). Conversions from MIE occurred in SEMS group 13.3% vs control group 3.3%. Conclusion: SEMS application has no negative effect on OS, PFS, complications or operative time. There was a trend towards increased incidence of intraoperative leakage, but our study groups were too small to determine any statistical differences. The result is contrary to that of recent multicentre database results, but these results reflect the results of specialized unit. Therefore, we conclude that preoperative SEMS insertion is a feasible and safe strategy when done in experienced centres as a bridge to surgery.