Preoperative Esophageal Stenting and 5-Year Survival in Patients Undergoing Esophagectomy for Esophageal Cancer: a Population-Based Nationwide Study from Finland

Journal of Gastrointestinal Surgery · 19 authors, 14 centres

AI SUMMARY

FIDELITY 100%

POPULATIONAdults undergoing curatively intended esophagectomy for esophageal cancer in Finland (1999–2016)

INTERVENTIONPreoperative esophageal stenting

COMPARISONNo preoperative esophageal stenting

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AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

Preoperative stenting was associated with higher 5-year mortality and significantly increased 90-day mortality after adjustment for confounding factors.

Full summary

306 CHARS

After adjustment, stenting was associated with higher 5-year mortality (HR 1.29, 95% CI 1.00–1.65) and significantly higher 90-day mortality (HR 2.49, 95% CI 1.27–4.87). Subgroup analyses in neoadjuvant-treated patients showed 5-year survival of 39.2% versus 46.4% and 90-day mortality of 8.5% versus 2.5%.

PICO

PPOPULATION

Adults undergoing curatively intended esophagectomy for esophageal cancer in Finland (1999–2016)

IINTERVENTION

Preoperative esophageal stenting

OOUTCOME

Primary: overall 5-year survival; Secondary: 90-day mortality

STUDY TYPE

cohort

SPECIALTY

surgery

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10267252

Preoperative Esophageal Stenting and 5-Year Survival in Patients Undergoing Esophagectomy for Esophageal Cancer: a Population-Based Nationwide Study from Finland

Journal of Gastrointestinal Surgery

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ABSTRACT

Background Preoperative esophageal stenting is proposed to have a negative effect on outcomes. The aim was to compare a 5-year survival in patients undergoing esophagectomy for esophageal cancer with and without preoperative esophageal stent in a population-based nationwide cohort from Finland. The secondary outcome was 90-day mortality. Methods This study included curatively intended esophagectomies for esophageal cancer in Finland between 1999 and 2016, with follow-up until December 31, 2019. Cox proportional hazards models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of overall 5-year and 90-day mortality. Model 1 was adjusted for age, sex, year of the surgery, comorbidities, histology, pathological stage, and neoadjuvant therapy. Model 2 included also albumin level and BMI. Result Of 1064 patients, a total of 134 patients underwent preoperative stenting and 930 did not. In both adjusted models 1 and 2, higher 5-year mortality was seen in patients with preoperative stent with HRs of 1.29 (95% CI 1.00–1.65) and 1.25 (95% CI 0.97–1.62), respectively, compared to no stenting. The adjusted HR of 90-day mortality was 2.49 (95% CI 1.27–4.87) in model 1 and 2.49 (95% CI 1.25–4.99) in model 2. When including only neoadjuvant-treated patients, those with preoperative stent had a 5-year survival of 39.2% compared to 46.4% without stent (adjusted HR 1.34, 95% CI 1.00–1.80), and a 90-day mortality rate of 8.5% and 2.5% (adjusted HR 3.99, 95% CI 1.51–10.50). Discussion This nationwide study reports worse 5-year and 90-day outcomes in patients with preoperative esophageal stent. Since residual confounding remains possible, observed difference could be only an association rather than the cause.

CITATION EXPORT

Olli Helminen, Eero Sihvo, Mika Helmiö et al.. Preoperative Esophageal Stenting and 5-Year Survival in Patients Undergoing Esophagectomy for Esophageal Cancer: a Population-Based Nationwide Study from Finland. Journal of Gastrointestinal Surgery. (2023). https://doi.org/10.1007/s11605-023-05643-7

AUTHORS

19 · 14 CENTRES

Olli Helminen, Eero Sihvo, Mika Helmiö, Heikki Huhta, Raija Kallio, Vesa Koivukangas, Arto Kokkola, Simo Laine, Elina Lietzen, Sanna Meriläinen, Vesa-Matti Pohjanen, Tuomo Rantanen, Ari Ristimäki, Jari V. Räsänen, Juha Saarnio, Vesa Toikkanen, Tuula Tyrväinen, Antti Valtola, Joonas H. Kauppila

1grid.10858.340000 0001 0941 4873Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
2grid.412326.00000 0004 4685 4917Department of Surgery, Oulu University Hospital, Kajaaninkatu 50, 90220 Oulu, Finland
3grid.460356.20000 0004 0449 0385Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
4grid.410552.70000 0004 0628 215XDivision of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
5grid.412326.00000 0004 4685 4917Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
6grid.15485.3d0000 0000 9950 5666Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
7grid.10858.340000 0001 0941 4873Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
8grid.9668.10000 0001 0726 2490Department of Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
9grid.15485.3d0000 0000 9950 5666Department of Pathology and HUSLAB, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
10grid.7737.40000 0004 0410 2071Applied Tumor Genomics Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
11grid.15485.3d0000 0000 9950 5666Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
12grid.502801.e0000 0001 2314 6254Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, University of Tampere, Tampere, Finland
13grid.412330.70000 0004 0628 2985Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
14grid.24381.3c0000 0000 9241 5705Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden