Temporary stent placement with concurrent chemoradiation therapy in patients with unresectable oesophageal carcinoma: Is there an optimal time for stent removal?

Objective: To investigate the influence of the timing of stent removal on the outcome of temporary stent placement with concurrent chemoradiation therapy in patients with unresectable oesophageal carcinoma. Methods: Retrospective analysis was performed on 52 patients undergoing temporary stent placement. Stents were electively removed within 4 weeks in 15 patients (group A), 4-6 weeks in 17 patients (group B) and after 6 weeks in 20 patients (group C). Recurrent symptoms after stent removal, dysphagia score and overall survival periods were compared among the groups. Results: Stent placement and removal were technically successful in all patients. The dysphagia score was significantly improved in all groups (P < 0.001). In 19 patients (36 %), recurrent symptoms occurred 15-441 days after stent removal. In group A, recurrent obstruction was significantly higher than in groups B (P = 0.049) and C (P = 0.019). Incidence of oesophago-respiratory fistulas in group C was significantly higher than in group A (P = 0.027). There was no significant difference in survival periods. Conclusion: The ideal time for stent removal likely falls between 4 and 6 weeks following the start of palliative CCRT allowing the temporary stents to relieve dysphagia effectively in patients with unresectable oesophageal carcinoma.