Conflict of interest: none declared.
Self-expanding metal stents (SEMS) for patients with advanced Esophageal cancer in Malawi: An effective palliative treatment†
Article first published online: 12 DEC 2011
Copyright © 2011 Wiley Periodicals, Inc.
Journal of Surgical Oncology
Volume 105, Issue 4, pages 410–414, 15 March 2012
How to Cite
Thumbs, A., Borgstein, E., Vigna, L., Kingham, T. P., Kushner, A. L., Hellberg, K., Bates, J. and Wilhelm, T. J. (2012), Self-expanding metal stents (SEMS) for patients with advanced Esophageal cancer in Malawi: An effective palliative treatment. J. Surg. Oncol., 105: 410–414. doi: 10.1002/jso.23003
- Issue published online: 6 FEB 2012
- Article first published online: 12 DEC 2011
- Manuscript Accepted: 21 NOV 2011
- Manuscript Received: 13 OCT 2011
- Press Trust Malawi
- Lions Club Blantyre
- Surgeons OverSeas
- esophageal carcinoma;
- rural Africa;
- resource-limited countries
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.
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.
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).
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.