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Self‐expanding metal stents (SEMS) for patients with advanced Esophageal cancer in Malawi: An effective palliative treatment
Author(s) -
Thumbs Alexander,
Borgstein Eric,
Vigna Leo,
Kingham T. Peter,
Kushner Adam L.,
Hellberg Kai,
Bates Jane,
Wilhelm Torsten J.
Publication year - 2011
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23003
Subject(s) - medicine , dysphagia , esophageal cancer , palliative care , palliative treatment , surgery , cancer , general surgery , nursing
Background and Objectives Esophageal cancer is common in Malawi and most patients are inoperable at time of diagnosis. The aim of this study was to prospectively evaluate palliative treatment with self‐expanding metal stents (SEMS) in Malawi, a low‐income country with limited medical resources. Methods Data of patients with advanced inoperable esophageal cancer were prospectively collected. Tumor and patient specifics, risk factors, dysphagia scores, complications, and survival were assessed. Follow‐up data for 1 year or until death were collected from 118/143 patients (83%) during clinic visits, home visits, or via cell phone. Results One hundred forty‐three patients were treated with 154 SEMS. Median survival was 210 days (95% CI: 150–262 days). Fourteen of 118 patients with complete follow‐up (11.9%) survived more than 1 year with longest documented survival of 406 days. The median dysphagia score improved from 3 at the time of presentation to 0 at the time of death. Early complications occurred in 4.2% (6/143), late complications in 11.9% of patients (14/118). The procedure related mortality was 2.1% (3/143). Conclusions SEMS is an appropriate palliative treatment in a resource‐limited environment. For the vast majority of patients a single intervention provides lasting improvement of dysphagia. J. Surg. Oncol. 2012;105:410–414. © 2011 Wiley Periodicals, Inc.