Is oesophageal stenting for cancer the answer? A report from a secondary hospital in the developing world

Abstract

Introduction. Oesophageal cancer causes much morbidity and mortality in South Africa. Social and economic constraints further impact on the management of these patients. Many prospective randomised trials of palliative treatment have been done in the developed world, not taking into account these socio-economic constraints. We present a study from Tshepong Hospital, a secondary hospital in South Africa, comparing stenting with radiation therapy in the palliative treatment of oesophageal cancer. Patients and methods. We retrospectively reviewed the data on 30 patients seen between February 2005 and January 2008. All presented with inoperable oesophageal cancer and were palliated with either stenting (N=18) or radiotherapy (N=12). We compared number of admissions, length of hospital stay and time from when first seen to intervention as primary outcomes. Results. The number of admissions, length of hospital stay and days to procedure were significantly lower in the stent group. No major complications resulting from brachytherapy were reported. Complications in the stent group included chest pain, tumour overgrowth, stent migration and death. Discussion. Studies have shown the superiority of brachytherapy over stenting with regard to long-term palliation and number of complications. In our setting, however, socioeconomic constraints result in a delay in treatment. Given the short survival expected in these patients, stenting may be a reasonable option to consider given the decreased time to final intervention and hospital stay in patients with a poor prognosis. Adopting a prognostic score can help in identifying these patients.