474. SELF EXPANDABLE METAL STENT AS A BRIDGE TO RESECTION IN ESOPHAGEAL CANCER – A NATIONAL REGISTER ANALYSIS ON MORTALITY

Abstract Background Patients with esophageal cancer commonly present with malnutrition and weight loss due to dysphagia. Self Expandable Metal Stent (SEMS) have been used to relieve dysphagia and optimize nutrition prior to surgery and during neoadjuvant treatment. However, SEMS is associated with various complications and studies have further found a decreased survival in patients preoperatively treated with SEMS. The aim of the study was to investigate whether SEMS as a bridge to resection has an impact on mortality. Methods All patients with esophageal cancer in the Swedish National Register for Esophageal and Gastric cancer (NREV) between 2006 and 2018 were included. Patient data, tumor and treatment characteristics were assessed. Resected patients who received SEMS preoperatively were compared to patients who did not receive SEMS with regard to patient, tumor and treatment characteristics. Overall survival was explored by multivariable Cox regression models and adjusted for age, ASA score, preoperative BMI, clinical T-stage and neoadjuvant chemo- or chemoradiotherapy. Primary outcome was mortality. Results In total, 1841 resected patients with esophageal cancer and curative intent were identified. Of these, 83 patients received SEMS as a bridge to resection. T-stage was more advanced in patients with SEMS than those without SEMS, but there was no difference in N-stage, ASA-score or preoperative BMI. Early mortality (<90 days) and total mortality was higher in the SEMS group (12.4% vs 5.3%, p=0.002 and 77.1 % vs 58.2%, p<0.001 respectively. Mean follow-up time was 45 months for the all included patients. SEMS was an independent predictor of earlier death in multivariable analysis (Hazard Ratio 1,710; CI 95% 1,27-2,23; p=<0,001). Conclusion SEMS as a bridge to resection in the treatment of esophageal cancer seem to be associated with poor outcome with regard to both early and late mortality.