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Outcomes of esophageal bypass surgery and self-expanding metallic stent insertion in esophageal cancer: reevaluation of bypass surgery as an alternative treatment

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Abstract

Purpose

Advanced esophageal cancer often results in esophageal stenosis or tracheoesophageal fistula. Esophageal bypass surgery and esophageal stent insertion are palliative treatments for esophageal cancer. With improvements in metallic stents and the stent insertion technique, esophageal stent insertion appears to be performed more frequently than bypass surgery, worldwide. The aim of this study was to evaluate the outcomes of bypass surgery and stent insertion in our hospital and reevaluate which patients would benefit from bypass surgery.

Methods

A total of 70 esophageal cancer patients who could not tolerate oral feeding due to esophageal stenosis or tracheoesophageal fistula underwent palliative treatment [esophageal bypass surgery (N = 34) and esophageal stent insertion (N = 36)] at Kumamoto University. We retrospectively investigated the clinicopathological factors, postoperative outcomes, and complications.

Results

Both treatments could significantly improve the amount of food intake and the dietary form (P < 0.01). The length of hospital stay was shorter (P < 0.01) and complications associated with treatment were reduced in the stent group (P = 0.03). The overall survival did not differ significantly between the groups (log rank P = 0.22). Importantly, in the bypass surgery group, the patients who received postoperative treatment had a better prognosis than those who did not receive postoperative treatment (log rank P < 0.01).

Conclusion

Both bypass surgery and stent insertion allowed oral intake in patients who could not tolerate oral feeding because of esophageal stenosis or tracheoesophageal fistula. Considering that patients who undergo stent insertion have a shorter hospital stay and fewer complications, stent insertion may be a better first choice for treatment than bypass surgery. However, bypass surgery may be an option for patients who can tolerate postoperative treatment.

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Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Daichi Nomoto, Yoshifumi Baba, Takahiko Akiyama, Kazuo Okadome, Tomoyuki Uchihara, Kazuto Harada, Kojiro Eto, Yukiharu Hiyoshi, Yohei Nagai, Takatsugu Ishimoto, Masaaki Iwatsuki, Shiro Iwagami, Yuji Miyamoto, Naoya Yoshida & Hideo Baba

  2. Department of Next-Generation Surgical Therapy Development, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Yoshifumi Baba

  3. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Masayuki Watanabe

  4. Center for Metabolic Regulation of Healthy Aging, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Hideo Baba

Authors
  1. Daichi Nomoto
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  2. Yoshifumi Baba
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  3. Takahiko Akiyama
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  4. Kazuo Okadome
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  5. Tomoyuki Uchihara
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  6. Kazuto Harada
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  7. Kojiro Eto
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  8. Yukiharu Hiyoshi
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  9. Yohei Nagai
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  10. Takatsugu Ishimoto
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  11. Masaaki Iwatsuki
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  12. Shiro Iwagami
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  13. Yuji Miyamoto
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  14. Naoya Yoshida
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  15. Masayuki Watanabe
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  16. Hideo Baba
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Contributions

Daichi Nomoto, Yoshifumi Baba, Kazuto Harada, and Yohei Nagai participated in the study conception and design; Daichi Nomoto, Takahiko Akiyama, Tomoyuki Uchihara, Kojiro Eto, and Yukiharu Hiyoshi in the acquisition of data; Daichi Nomoto, Yoshifumi Baba, Kazuo Okadome, Yohei Nagai, Takatsugu Ishimoto, Masaaki Iwatsuki, and Shiro Iwagami in the analysis and interpretation of data; Daichi Nomoto and Yoshifumi Baba in the drafting of manuscript; and Yuji Miyamoto, Naoya Yoshida, Masayuki Watanabe, and Hideo Baba in the review and editing.

Corresponding author

Correspondence to Hideo Baba.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All experimental protocols described in this study were approved by the Institutional Review Board of Kumamoto University (#1909) and conform to the provisions of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Nomoto, D., Baba, Y., Akiyama, T. et al. Outcomes of esophageal bypass surgery and self-expanding metallic stent insertion in esophageal cancer: reevaluation of bypass surgery as an alternative treatment. Langenbecks Arch Surg 405, 1111–1118 (2020). https://doi.org/10.1007/s00423-020-01969-x

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  • DOI: https://doi.org/10.1007/s00423-020-01969-x

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