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n South African Journal of Surgery - Trial of self-expandable metallic stents in the palliation of tracheo-oesophageal fistula in carcinoma of the oesophagus : general surgery
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. 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.
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