Outcome, survival, and costs in patients undergoing intubation for carcinoma of the esophagus

• Published in: The American journal of surgery Vol. 174; no. 3; pp. 316 - 319
• Main Authors: O'Hanlon, Deirdre M., Callanan, Keith, Karat, Daya, Crisp, William, Michael Griffin, S.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.1997; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Complications; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Esophageal cancer; Esophageal carcinoma; Esophageal Neoplasms - complications; Esophageal Neoplasms - mortality; Esophagus; Female; Humans; Implants; Insertion; Intubation - adverse effects; Intubation - economics; Male; Median (statistics); Medical sciences; Morbidity; Mortality; Palliation; Palliative Care; Patients; Prospective Studies; Prostheses and Implants - adverse effects; Prostheses and Implants - economics; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival; Survival Analysis; Treatment Outcome; Human; Wilson theory; Endoprosthesis; Costs; Carcinoma; Prognosis; Esophageal disease; Malignant tumor; Survival; Esophagus; Prospective; Randomization; Surgery; Digestive diseases; Technique
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(97)00104-9

In this prospective study a consec utive series of 70 patients undergoing insertion of a Wilson-Cook endoprosthesis for palliation of esophageal carcinoma was examined. The tube was inserted endoscopically using intravenous sedation and a pulsion technique. The patients had a mean (SEM) age of 70.7 (1.5) years and 44 (63%) were men. Two patients died in hospital and 2 died after discharge, giving a procedure-related mortality of 2.8% and a 30-day mortality of 5.7%. Nine patients experienced complications, giving a morbidity rate of 12.8% following the initial procedure. Twenty patients required a second or further procedure. The indications were tube migration in 22 cases, obstruction in 10, and fistula formation in 2 patients. Thirty-day mortality in this group was significantly greater than after a first procedure (7 patients, 20.1%; P < 0.05). The median survival following insertion of a Wilson-Cook endoprosthesis was 16 weeks. This study describes a safe, effective method for insertion of an endoprosthesis, with a low morbidity and mortality. The average cost for endoscopic insertion of a Wilson-Cook endoprosthesis in this unit is $1,600, and in view of the short median survival in this group of patients, the introduction of costly self-expanding stents is not warranted without demonstrable benefits in a controlled, prospective, randomized clinical trial.