Korean J Gastroenterol.  2018 Mar;71(3):124-131. 10.4166/kjg.2018.71.3.124.

Comparative Study of Esophageal Self-expandable Metallic Stent Insertion and Gastrostomy Feeding for Dysphagia Caused by Lung Cancer

• Kim J
• Min YW
• Lee H
• Min BH
• Lee JH
• Rhee PL
• Kim JJ

• KMID: 2407669
• DOI: http://doi.org/10.4166/kjg.2018.71.3.124

Abstract

BACKGROUND/AIMS
Dysphagia is encountered in a large proportion of patients with lung cancer and is associated with malnutrition and a poor quality of life. This study compared the clinical outcomes of self-expandable metallic stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding for patients with lung cancer and dysphagia.
METHODS
A total of 261 patients with lung cancer, who underwent either SEMS insertion (stent group) or PG (gastrostomy group) as an initial treatment procedure for dysphagia between July 1997 and July 2015 at the Samsung Medical Center, were reviewed retrospectively, and 84 patients with esophageal obstruction were identified. The clinical outcomes, including the overall survival, additional intervention, complications, and post-procedural nutritional status in the two groups, were compared.
RESULTS
Among the 84 patients finally analyzed, 68 patients received SEMS insertion and 16 had PG. The stent group had less cervical obstruction and more mid-esophageal obstruction than the gastrostomy group. The Kaplan-Meier curves revealed similar overall survival in the two groups. Multivariate analysis showed that the two modalities had similar survival rates (PG compared with SEMS insertion, hazard ratio 0.682, p=0.219). Fifteen patients (22.1%) in the stent group received additional intervention, whereas there was no case in the gastrostomy group (p=0.063). The decrease in the serum albumin level after the procedure was lower in the gastrostomy group than in the stent group (-0.20±0.54 g/dL vs. -0.65±0.57 g/dL, p=0.013)
CONCLUSIONS
SEMS insertion and PG feeding for relieving dysphagia by lung cancer had a comparable survival outcome. On the other hand, PG was associated with a better nutritional status.

Keyword

Self expandable metallic stents; Gastrostomy; Esophageal stenosis; Lung cancer; Dysphagia

MeSH Terms

Deglutition Disorders*
Esophageal Stenosis
Gastrostomy*
Hand
Humans
Lung Neoplasms*
Lung*
Malnutrition
Multivariate Analysis
Nutritional Status
Quality of Life
Retrospective Studies
Self Expandable Metallic Stents
Serum Albumin
Stents*
Survival Rate
Serum Albumin

Figure

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  Fig. 1. Flow chart of patient selection. RT, radiotherapy.

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  Fig. 2. Kaplan-Meier curves for the overall survival in lung cancer patients who received either esophageal stent or percutaneous gastrostomy for malignant dysphagia.

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  Fig. 3. Subgroup analysis of the overall survival according to the 7th AJCC staging in NSCLC patients. (A) Kaplan-Meier curves for the overall survival in NSCLC stage III patients who received either esophageal stent or percutaneous gastrostomy for malignant dysphagia. (B) Kaplan-Meier curves for the overall survival in NSCLC stage IV patients who received either esophageal stent or percutaneous gastrostomy for malignant dysphagia. AJCC, American Joint Committee on Cancer; NSCLC, non-small cell lung cancer.

Reference

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