Risk factors of short-term mortality after stent implantation for advanced esophageal squamous cell carcinoma with malignant strictures

Objective To investigate the risk factors of short-term mortality after stent implantation for advanced esophageal squamous cell carcinoma (ESCC) with malignant strictures. Methods The retrospective case-control study was conducted. The clinicopathological data of 133 patients with advanced ESCC with malignant strictures who underwent stent implantation at the Affiliated Hospital of North Sichuan Medical College from January 2013 to August 2015 were collected. All the patients were followed up using telephone interview, door-to-door interview and regular reexamination up to March 2016. Follow-up included the postoperative pain and survival of patients. Survival time: short-term mortality was less than or equal to 3 months after stent implantation and medium- and long-term mortality was more than 3 months after stent implantation. Observation indicators included: (1) results of treatment and follow-up, (2) results of univariate analysis affecting postoperative short-term mortality: gender, age, tumor location, major diameter of tumor, significant enlargement of mediastinal lymph nodes, clinical staging, preoperative comorbidities, preoperative esophagectasia, preoperative Stooler grade, type and length of stent, operation time, postoperative Stooler grade and postoperative severe pain, (3) results of multivariate analysis affecting postoperative short-term mortality. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were represented as M (range). The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model. Results (1) Results of treatment and follow-up: 133 patients received successful stent implantation, without the occurrence of death. All the 133 patients were followed up for 4.3 months (range, 0.0-15.0 months). During the follow-up, a median survival time of 133 patients was 4.0 months (range, 0.0-15.0 months). Of 133 patients, 53 died in postoperative month 3 or less and 80 died after 3 months postoperatively. Sixty-four patients died of recurrence and metastatsis of ESCC, 42 died of vomitting of blood and 27 died of other causes. (2) Results of univariate analysis affecting postoperative short-term mortality: significant enlargement of mediastinal lymph nodes and postoperative severe pain were the risk factors affecting short-term mortality after stent implantation for advanced ESCC with malignant strictures (χ2=3.960, 20.332, P<0.05). (3) Results of multivariate analysis affecting postoperative short-term mortality: significant enlargement of mediastinal lymph nodes and postoperative severe pain were the independent risk factors affecting short-term mortality after stent implantation for advanced ESCC with malignant strictures (OR=4.313, 8.094, 95% confidence interval: 1.299-14.325, 2.985-21.947, P<0.05). Conclusions Significant enlargement of mediastinal lymph nodes and postoperative severe pain are the independent risk factors affecting short-term mortality within month 3 after stent implantation for advanced ESCC with malignant strictures. Stent Implantation should strictly follow indications. The symptoms as severe pain should be controlled actively to avoid the short-term mortality and postoperative complications after stent implantation. Key words: Esophageal neoplasms; Stenting implanation; Death; Risk factors