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Palliation of dysphagia in patients with non-curable esophageal cancer – a retrospective Danish study from a highly specialized center

Abstract

Purpose

A majority of the patients with esophageal cancer (EC) suffer from dysphagia. Several endoscopic treatment options are available such as stent placement, argon plasma coagulation, and esophageal dilatation. This study aimed to map the use of endoscopic dysphagia relieving interventions and secondly investigate possible impact on survival.

Methods

Data was collected at the Dept. of Surgery & Transplantation, Rigshospitalet, Denmark. Patients with non-curable EC referred from 2016 to 2019 were included. Type of dysphagia treatment, complications and the need for repeated treatments, and survival were registered.

Results

In the study, 601 patients were included. Forty-five percent were treated with an endoscopic procedure due to dysphagia (82% had a stent placed). The median time from diagnosis to intervention was 24 days. The overall complication rate was 35% (38% in the stent group and 20% in the non-stent group, p = 0.03) and 13% of the patients were readmitted due to a complication. After 26% of the procedures, a repeated treatment was required. Patients having an endoscopic intervention had a worsened survival prognosis compared with the patients in the non-intervention group (HR: 2.17, 95% CI: 1.80–2.61, p < 0.001). In the sub analysis where only patients who had an intervention was included, a survival difference in favor of the non-stent group was found (HR: 0.61, 95% CI: 0.43–0.86, p = 0.005).

Conclusion

In this cohort, the incidence of endoscopic procedures was high, complication rates were considerable, and many the patients required a second treatment. A survival difference was seen, where the patients who had a stent placed seemed to have the worst survival outcomes.

However, the causal relationship is yet to be determined why the results must be interpreted carefully. New interventions and tailored approaches that may positively affect functional and long-term oncological outcomes are highly warranted and this should preferably be investigated in randomized clinical trials.

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Data availability

Raw data were generated at Department of Surgery and Transplantation, Rigshospitalet, University of Copenhagen. Derived data supporting the findings of this study are available from the corresponding author on request.

Code availability

The code can be accessed from the corresponding author on request.

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Acknowledgements

Thanks to Grace Konstantin for proofreading this paper.

Funding

Charlotte Egeland obtained a Ph.D. fellow grant from “Rigshospitalets Forskningspulje” to cover salary expenses (2 Million DKK). Besides from this, this research project did not receive any specific grant from funding agencies.

Author information

Authors and Affiliations

Authors

Contributions

Guarantor of integrity of the entire study: Michael Achiam.

Study concepts and design: Charlotte Egeland, Lene Baeksgaard, Julie Gehl, Ismail Gögenur, Michael Achiam

Literature search: Charlotte Egeland

Clinical studies: N/A

Experimental studies/data analysis: Charlotte Egeland, Laser Arif Bazancir, Nam Hai Bui

Statistical analysis: Charlotte Egeland

Manuscript preparation: Charlotte Egeland, Michael Achiam

Manuscript editing: Charlotte Egeland, Laser Arif Bazancir, Nam Hai Bui, Lene Baeksgaard, Julie Gehl, Ismail Gögenur, Michael Achiam

Corresponding author

Correspondence to Charlotte Egeland.

Ethics declarations

Ethics approval

The trial was approved as a quality control trial by the hospital manager. All data in REDCap were pseudo-anonymized and only the investigators had access to the patient identification key.

Consent to participate

In our department, at the time of referral, all patients are asked to consent that their health data might be used in research, with permission from the hospital board, to a specific project.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

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Egeland, C., Bazancir, L.A., Bui, N.H. et al. Palliation of dysphagia in patients with non-curable esophageal cancer – a retrospective Danish study from a highly specialized center. Support Care Cancer (2022). https://doi.org/10.1007/s00520-022-07316-8

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  • DOI: https://doi.org/10.1007/s00520-022-07316-8

Keywords

  • Esophageal cancer
  • Dysphagia
  • Palliation
  • Endoscopy
  • Esophageal stent