pp 1–7 | Cite as

Palliative interventions for patients with incurable locally advanced or metastatic thoracic esophageal carcinoma

  • Tomoyuki KakutaEmail author
  • Shin-ichi Kosugi
  • Hiroshi Ichikawa
  • Takaaki Hanyu
  • Takashi Ishikawa
  • Tatsuo Kanda
  • Toshifumi Wakai
Original Article



The aim of this study was to assess the clinical outcomes of palliative interventions for patients with incurable locally advanced or metastatic esophageal carcinoma.


A total of 131 patients with thoracic esophageal carcinoma who underwent palliative interventions were enrolled. Insertion of a self-expandable metallic stent (SEMS), tube enterostomy for enteral nutrition (EN), and palliative esophagectomy (PE) were performed in 38, 65, and 28 patients, respectively. The clinicopathological characteristics and clinical outcomes of each group were retrospectively reviewed.


Patients in the EN group frequently received chemoradiotherapy (P < 0.01). SEMS insertion, but not PE or EN, improved the mean dysphagia score after the intervention (P < 0.01). For the SEMS, EN, and PE groups, the occurrence of intervention-related complications was 31.6, 10.8, and 96.4%, respectively, the median survival time was 88, 208, and 226 days (P < 0.01), and the mean ratio of duration of home care to survival time was 28.9, 38.5, and 39.6% (P = 0.95).


SEMS insertion effectively relieved obstructive symptoms, but had no survival benefit. Tube enterostomy showed a low complication rate and has the potential to improve survival in combination with additional treatment, with no palliation of obstructive symptoms.


Palliative interventions Incurable esophageal carcinoma Palliation of obstructive symptoms 


Compliance with ethical standards

Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Informed consent or substitute for it was obtained from all patients for being included in this study.


  1. 1.
    Frenken M. Best palliation in esophageal cancer: surgery, stenting, radiation, or what? Dis Esophagus. 2001;14:120–3.CrossRefGoogle Scholar
  2. 2.
    Homs MYV, Steyerberg EW, Eijkenboom WMH, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicenter randomized trial. Lancet. 2004;364:1497–504.CrossRefGoogle Scholar
  3. 3.
    Burstow M, Kelly T, Panchani S, et al. Outcome of palliative esophageal stenting for malignant dysphagia: a retrospective analysis. Dis Esophagus. 2009;22:519–25.CrossRefGoogle Scholar
  4. 4.
    Besharat S, Jabbari A, Semnami S, et al. Inoperable esophageal cancer and outcome of palliative care. World J Gastroenterol. 2008;14:3725–8.CrossRefGoogle Scholar
  5. 5.
    Yajima K, Kanda T, Nakagawa S, et al. Self-expandable metallic stents for palliation of malignant esophageal obstruction: special reference to quality of life and survival patients. Dis Esophagus. 2004;17:71–5.CrossRefGoogle Scholar
  6. 6.
    Neil AC, Percival OB, Hiran CF, et al. Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann Thorac Surg. 2001;71:1797–802.CrossRefGoogle Scholar
  7. 7.
    Aoki T, Osaka Y, Takagi Y, et al. Comparative study of self-expandable metallic stent and bypass surgery for inoperable esophageal cancer. Dis Esophagus. 2001;14:208–11.CrossRefGoogle Scholar
  8. 8.
    Tanaka T, Fujita H, Matono S, et al. Outcomes of multimodality therapy for stage IVB esophageal cancer with distant organ metastasis (M1-Org). Dis Esophagus. 2010;23:646–51.CrossRefGoogle Scholar
  9. 9.
    George S, Ines G, Constantine K, et al. Survival after chemotherapy and/or radiotherapy versus self-expanding metal stent insertion in the setting of inoperable esophageal cancer: a case control study. BMC Cancer. 2012;12:70.CrossRefGoogle Scholar
  10. 10.
    Battersby NJ, Bonney GK, Subar D, et al. Outcomes following oesophageal stent insertion for palliation of malignant strictures: a large single centre series. J Surg Oncol. 2012;105:60–5.CrossRefGoogle Scholar
  11. 11.
    Siddiqui AA, Glynn C, Loren D, et al. Self-expanding plastic esophageal stents versus jejunostomy tubes for the maintenance of nutrition during neoadjuvant chemoradiation therapy in patients with esophageal cancer: a retrospective study. Dis Esophagus. 2009;22:216–22.CrossRefGoogle Scholar
  12. 12.
    Grilo A, Santos CA, Fonseca J. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting. Arq Gastroenterol. 2012;49:227–31.CrossRefGoogle Scholar
  13. 13.
    Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. Oxford: Wiley-Blackwell; 2010.Google Scholar
  14. 14.
    Neuhaus H, Hoffmann W, Dittler HJ, et al. Implantation of self-expanding esophageal metal stents for palliation of malignant dysphagia. Endoscopy. 1992;24:405–10.CrossRefGoogle Scholar
  15. 15.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefGoogle Scholar
  16. 16.
    Madhusudhan C, Saluja SS, Pal S, et al. Palliative stenting for relief of dysphagia in patients with inoperable esophageal cancer: impact on quality of life. Dis Esophagus. 2009;22:331–6.CrossRefGoogle Scholar
  17. 17.
    Diamantis G, Scarpa M, Bocus P, et al. Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia. World J Gastroenterol. 2011;17:144–50.CrossRefGoogle Scholar
  18. 18.
    Schoppmann SF, Langer FB, Prager G, et al. Outcome and complications of long-term self-expanding esophageal stenting. Dis Esophagus. 2013;26:154–8.CrossRefGoogle Scholar
  19. 19.
    Stewart DJ, Balamurugan R, Everitt NJ, et al. Ten-year experience of esophageal self-expanding metal stent insertion at a single institution. Dis Esophagus. 2013;26:276–81.CrossRefGoogle Scholar
  20. 20.
    Yokota T, Kato K, Hamamoto Y, et al. Phase II study of chemo-selection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy and subsequent conversion surgery for locally advanced unresectable oesophageal cancer. Br J Cancer. 2016;115:1328–34.CrossRefGoogle Scholar
  21. 21.
    Penniment MG, Deleso PB, Harvey JA, et al. Palliative chemoradiotherapy versus radiotherapy alone for dysphagia in advanced oesophageal cancer: a multicentre randomised controlled trial (TROG 03.01). Lancet Gastroenterol Hepatol. 2018;3:114–24.CrossRefGoogle Scholar
  22. 22.
    Murray LJ, Din OS, Kumar VS, et al. Palliative radiotherapy in patients with esophageal carcinoma: a retrospective review. Pract Radiat Oncol. 2012;2:257–64.CrossRefGoogle Scholar
  23. 23.
    Welsch J, Kup PG, Nieder C, et al. Survival and symptom relief after palliative radiotherapy or esophageal cancer. J Cancer. 2016;7:125–30.CrossRefGoogle Scholar
  24. 24.
    Nishimura Y, Nagata K, Katano S, et al. Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents: a questionnaire survey of the Japanese Society for Esophageal Diseases. Int J Radiat Oncol Biol Phys. 2003;56:1327–32.CrossRefGoogle Scholar
  25. 25.
    Adamson D, Blazeby J, Nelson A, et al. Palliative radiotherapy in addition to self-expanding metal stent for improving dysphagia and survival in advanced oesophageal cancer (ROCS: Radiotherapy after Oesophageal Cancer Stenting): study protocol for a randomized controlled trial. Trials. 2014;15:402.CrossRefGoogle Scholar
  26. 26.
    Adler DG, Fang J, Wong R, et al. Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy. Gastrointest Endosc. 2009;70:614–9.CrossRefGoogle Scholar
  27. 27.
    Bower M, Jones W, Vessels B, et al. Nutritional support with endoluminal stenting during neoadjuvant therapy for esophageal malignancy. Ann Surg Oncol. 2009;16:3161–8.CrossRefGoogle Scholar
  28. 28.
    Fayers PM, Aaronson NK, Bjordal K, on behalf of the EORTC Quality of Life Group, et al. The EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: EORTC; 2001.Google Scholar

Copyright information

© The Japan Esophageal Society and Springer 2019

Authors and Affiliations

  • Tomoyuki Kakuta
    • 1
    Email author
  • Shin-ichi Kosugi
    • 2
  • Hiroshi Ichikawa
    • 1
  • Takaaki Hanyu
    • 1
  • Takashi Ishikawa
    • 1
  • Tatsuo Kanda
    • 3
  • Toshifumi Wakai
    • 1
  1. 1.Division of Digestive and General SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
  2. 2.Department of Digestive and General Surgery, Uonuma Institute of Community MedicineNiigata University Medical and Dental HospitalMinami-UonumaJapan
  3. 3.Department of SurgerySanjo General HospitalNiigataJapan

Personalised recommendations