Eficacia y seguridad de endoprótesis metálicas autoexpandibles en el tratamiento paliativo del cáncer de esófago
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2017
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Introducción: En Ecuador, el Instituto Oncológico Nacional (ION) SOLCA “Dr. Juan Tanca Marengo”, constituye el centro de referencia oncológica a nivel nacional. Solo durante el periodo comprendido entre el año 2010 - 2016, esta institución reportó un total de 41 casos de cáncer de esófago irresecables. Debido a la alta morbimortalidad asociada con la paliación quirúrgica, se han vuelto de elección tratamientos paliativos menos invasivos como la colocación de endoprótesis metálicas autoexpandibles (EPMA), las cuales se han convertido en el método paliativo de elección. Objetivo: Demostrar la eficacia y seguridad de la colocación de endoprótesis metálica autoexpandible en el tratamiento paliativo de cáncer de esófago, en el Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”. Metodología: Se diseñará un estudio cuantitativo, observacional, descriptivo, longitudinal prospectivo, de recolección retrospectiva, del tipo cohorte histórico. El universo comprende aquellos pacientes con diagnóstico histopatológico de cáncer de esófago irresecable atendidos por el servicio de Gastroenterología del Instituto Oncológico Nacional (ION) SOLCA, “Dr. Juan Tanca Marengo”, desde octubre del 2012 a octubre de 2016. Se recuperó la información pertinente, suficiente como para reconstruir un seguimiento clínico no menor a seis meses, a fin de establecer expectativa de vida. Resultados: En total se recuperó 19 pacientes. La edad promedio fue de 68 años. Prevaleció el género masculino (14/19 casos, 73.7%). El diagnóstico más frecuente fue el carcinoma escamocelular (11/19 casos, 57,9%), seguido del adenocarcinoma (7/19 casos, 36,8%). Un caso correspondió a infiltración maligna a causa de un cáncer broncopulmonar. Todos los casos fueron de estadio localmente avanzado (III B, 10/19 casos, 52,6%) o superior (IV A – B, 9/19 casos 47,4%). La ubicación más frecuente fue a nivel del tercio medio (13/19 casos, 68,4%). La presencia de fístula traqueo-esofágica estuvo frecuente en aproximadamente una cuarta parte de la población (5/19 casos, 26,3%). De estos, 1/5 fue post-radioterapia. 18/19 casos (94,8%) la indicación de la colocación de la prótesis fue por estenosis esofágica. La presencia de fístula coexistió en 4/18 (22,2%). Solo hubo un caso en que la presencia de la fístula traqueo-esofágica no estuvo asociada ni a estenosis ni a la enfermedad maligna subyacente como tal (post-radioterapia). Se empleó prótesis cubierta en 6/19 casos (31,6%) y parcialmente cubierta en 13/19 (68.4%). Conclusión: La endoprótesis metálica autoexpandible es el tratamiento paliativo más recomendado en la estenosis maligna del esófago no sólo porque es un procedimiento seguro y con gran tasa de éxito, sino porque repercute significativamente en el mejoramiento de la disfagia y en la calidad de vida de estos pacientes.
Introduction: In Ecuador, the National Oncological Institute (ION) SOLCA "Dr. Juan Tanca Marengo ", is the national reference center for oncology. Only during the period between 2010-2016, this institution reported a total of 41 cases of unresectable esophageal cancer. Due to the high morbidity and mortality associated with surgical palliation, less invasive palliative treatments have been chosen, such as the placement of self-expanding metal endoprostheses (EPMA), which have become the palliative method of choice. Objective: To demonstrate the efficacy and safety of self-expanding metallic stent placement in the palliative treatment of esophageal cancer at the National Cancer Institute "Dr. Juan Tanca Marengo. " Methodology: A quantitative, observational, descriptive, longitudinal, prospective, retrospective, historical cohort type study will be designed. The universe includes those patients with histopathological diagnosis of unresectable esophageal cancer treated by the Gastroenterology service of the National Oncological Institute (ION) SOLCA, "Dr. Juan Tanca Marengo ", from October 2012 to October 2016. Relevant information was recovered, enough to reconstruct a clinical follow-up of at least six months, in order to establish life expectancy. Results: In total, 19 patients recovered. The average age was 68 years. Male gender prevailed (14/19 cases, 73.7%). The most frequent diagnosis was squamous cell carcinoma (11/19 cases, 57.9%), followed by adenocarcinoma (7/19 cases, 36.8%). One case corresponded to malignant infiltration due to bronchopulmonary cancer. All cases were locally advanced stage (III B, 10/19 cases, 52.6%) or higher (IV A - B, 9/19 cases 47.4%). The most frequent location was at the level of the middle third (13/19 cases, 68.4%). The presence of tracheoesophageal fistula was frequent in approximately a quarter of the population (5/19 cases, 26.3%). Of these, 1/5 was post-radiotherapy. 18/19 cases (94.8%) the indication of the placement of the prosthesis was due to esophageal stenosis. The presence of fistula coexisted in 4/18 (22.2%). There was only one case in which the presence of the tracheo-oesophageal fistula was not associated with stenosis or the underlying malignant disease as such (post-radiotherapy). A covered prosthesis was used in 6/19 cases (31.6%) and partially covered in 13/19 (68.4%). Conclusion: The self-expanding metal endoprosthesis is the most recommended palliative treatment in malignant stenosis of the esophagus, not only because it is a safe procedure with a high success rate, but also because it significantly affects the improvement of dysphagia and the quality of life of these patients.
Introduction: In Ecuador, the National Oncological Institute (ION) SOLCA "Dr. Juan Tanca Marengo ", is the national reference center for oncology. Only during the period between 2010-2016, this institution reported a total of 41 cases of unresectable esophageal cancer. Due to the high morbidity and mortality associated with surgical palliation, less invasive palliative treatments have been chosen, such as the placement of self-expanding metal endoprostheses (EPMA), which have become the palliative method of choice. Objective: To demonstrate the efficacy and safety of self-expanding metallic stent placement in the palliative treatment of esophageal cancer at the National Cancer Institute "Dr. Juan Tanca Marengo. " Methodology: A quantitative, observational, descriptive, longitudinal, prospective, retrospective, historical cohort type study will be designed. The universe includes those patients with histopathological diagnosis of unresectable esophageal cancer treated by the Gastroenterology service of the National Oncological Institute (ION) SOLCA, "Dr. Juan Tanca Marengo ", from October 2012 to October 2016. Relevant information was recovered, enough to reconstruct a clinical follow-up of at least six months, in order to establish life expectancy. Results: In total, 19 patients recovered. The average age was 68 years. Male gender prevailed (14/19 cases, 73.7%). The most frequent diagnosis was squamous cell carcinoma (11/19 cases, 57.9%), followed by adenocarcinoma (7/19 cases, 36.8%). One case corresponded to malignant infiltration due to bronchopulmonary cancer. All cases were locally advanced stage (III B, 10/19 cases, 52.6%) or higher (IV A - B, 9/19 cases 47.4%). The most frequent location was at the level of the middle third (13/19 cases, 68.4%). The presence of tracheoesophageal fistula was frequent in approximately a quarter of the population (5/19 cases, 26.3%). Of these, 1/5 was post-radiotherapy. 18/19 cases (94.8%) the indication of the placement of the prosthesis was due to esophageal stenosis. The presence of fistula coexisted in 4/18 (22.2%). There was only one case in which the presence of the tracheo-oesophageal fistula was not associated with stenosis or the underlying malignant disease as such (post-radiotherapy). A covered prosthesis was used in 6/19 cases (31.6%) and partially covered in 13/19 (68.4%). Conclusion: The self-expanding metal endoprosthesis is the most recommended palliative treatment in malignant stenosis of the esophagus, not only because it is a safe procedure with a high success rate, but also because it significantly affects the improvement of dysphagia and the quality of life of these patients.
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NEOPLASIAS ESOFAGICAS, STENTS METALICOS AUTOEXPANDIBLES, ESCALA KARNOFSKY, EPIDEMIOLOPGIA DESCRIPTIVA, HOSPITAL SOLCA DE GUAYAQUIL, CANTON GUAYAQUIL, ECUADOR, ESTUDIOS RETROSPECTIVOS, ESTUDIOS RETROSPECTIVOS