The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Randomized clinical trial comparing self‐expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancer. BJS 2002; 89: 985-992.

Published: 29th November 2002

Authors: C. A. O'Donnell, G. M. Fullarton, E. Watt, K. Lennon, G. D. Murray, J. G. Moss et al.

Background

There is little evidence of the clinical and cost effectiveness of self‐expanding metallic stents in the palliation of oesophageal cancer. The aims of this randomized trial were to evaluate the immediate and medium‐term clinical outcomes following palliative intubation, examine patient quality of life, and evaluate costs and benefits from the perspective of the health service.

Method

Fifty patients with inoperable oesophageal cancer were randomly allocated a metallic stent (n = 25) or plastic endoprosthesis (n = 25). Patients were followed up monthly until death.

Results

There was no significant difference in procedure‐related complications or mortality rate between the two groups. There was a trend towards significance in favour of metallic stents with respect to quality of life and survival (median survival 62 versus 107 days for plastic prosthesis and metallic stent respectively). The cost of the initial placement of metallic stents was significantly higher than that of plastic endoprostheses (£983 versus£296). After 4 weeks, cost differences were no longer significant.

Conclusion

Metallic stents may contribute to improved survival and quality of life in patients with oesophageal cancer. Although initially more expensive, this cost difference does not last beyond 4 weeks. A larger trial involving approximately 300 patients would be required to detect a quality of life benefit of the magnitude observed in this trial. © 2002 British Journal of Surgery Society Ltd

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