Back to 2025 Abstracts
PALLIATIVE INTERVENTION FOR OBSTRUCTIVE GASTROESOPHAGEAL CANCER: A SIGNIFICANT IMPACT ON END-OF-LIFE QUALITY
Kalvin Zee
*, Cole Myers, Viet Le
Surgery, MercyOne, Des Moines, IA
Background: Symptomatic palliation and nutritional support are important goals of care in patients with obstructive gastroesophageal (GE) cancer. Over 50% of newly diagnosed GE carcinomas will be found to have unresectable disease at the time of diagnosis. Obstruction often develops as a natural course of the disease, creating a significant negative impact on quality of life and prognosis. While many interventions have been developed to address obstruction, the most accessible options remain enteral access via surgical feeding tubes and esophageal stents. Both interventions implement different strategies to address obstruction. The comparative impact on healthcare resource utilization and end quality of life remains unclear. This study aims to compare the two palliative enteral access interventions (EAI) for addressing obstruction and the need for subsequent re-interventions in these patients.
Methods: A single institution retrospective cohort study was conducted at MercyOne Medical Center. Patients diagnosed with GE cancer from 2010 – 2020 were screened, and those with advanced or unresectable disease who underwent palliative EAI (esophageal stent vs surgical feeding tube) were included. The primary outcome assessed was the need for reintervention after index EAI. Other treatment outcomes were also evaluated between palliative EAI groups.
Results: A total of 286 patients were screened over the ten-year period, and 78 patients met inclusion criteria. Of the patient cohort, 35.9% (n=28) underwent initial stent placement while 64.1% (n=50) underwent initial surgical feeding tube placement. There was a statistically significant difference in the reintervention rate between the two groups. 25.6% of patients within the stent group required further interventions vs 6.0% of patients in the surgical feeding tube group (p=0.006). In addition, patients with surgical feeding tubes had higher rates of receiving their intended oncologic treatment compared to those who had initial esophageal stent placement (82% vs 60.7%, p=0.039).
Conclusion: There was a significantly higher rate of re-intervention and inability to receive intended oncologic treatment in patients who underwent index esophageal stent placement compared to those who had index surgical enteral feeding tube placement. The cost of procedural re-interventions is associated with increased hospital admissions and length of stays, adversely impacting end of life quality and healthcare costs. While randomized control trials are impractical due to patient preference and values in end-of-life palliation, future prospective studies may further elucidate patient’s well-being and financial impact of index EAI choice when providing palliative procedure counsel in this patient population.
Reintervention by Palliative Procedures
Patient Demographics and Outcomes
Back to 2025 Abstracts
