Nutritional Support with Endoluminal Stenting During Neoadjuvant Therapy for Esophageal Malignancy

Perioperative nutrition remains a significant problem in patients undergoing neoadjuvant treatment for esophageal cancer. The aim of this study was to evaluate the effectiveness of esophageal stenting, feeding tube placement, or observation among esophageal cancer patients receiving neoadjuvant therapy. A review of our prospectively maintained database of esophageal cancer patients identified 58 patients who underwent neoadjuvant chemoradiotherapy. Operative complications, tolerance of neoadjuvant therapy, and nutritional outcomes were evaluated according to the type of nutritional adjunct used. A total of 25 patients received esophageal stenting with self-expanding silicone stents. Of these, 19 patients had feeding tubes placed (without stenting), and 14 nonstented patients were maintained on oral diets alone. Stent patients showed a lower rate of interruption of chemoradiotherapy (8% vs. 29% vs. 47%, P = .011). The stent group also demonstrated greater mean improvement in albumin levels (0.14 g/dL vs. -0.39 g/dL vs. -0.45 g/dL, P < .001) and less percentage body weight loss (1.5% vs. 4.2% vs. 5.5%, P < .001). Nasogastric tubes were used for additional nutritional supplementation during the last week of therapy for two stent patients. The rate of stent migration was 24%. Overall, 31% of patients did not go on to resection because of progression to metastatic disease. The rate of major operative complication was 20% vs. 47% vs. 43% among stent, feeding tube, and oral nutrition patients respectively (P = .130). Esophageal stenting in the neoadjuvant setting offers improved results compared with feeding tubes both in maintaining preoperative nutrition and in tolerance of neoadjuvant chemoradiotherapy. Future protocols of patients treated with multimodal therapy for cancer of the esophagus should investigate the potential therapeutic benefit of using removable silicone esophageal stents as an alternative to feeding tubes.