Inoperable adenocarcinoma of the oesophagogastric junction

A comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis

E.I.T. Sihvo, Tuomo Pentikäinen, M.E. Luostarinen, O.J. Rämö, J.A. Salo

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Aims: Neither clinical nor financial comparisons yet exist between self-expanding metallic stents (SEMS) and laser therapy, concentrating on the treatment of obstructive adenocarcinomas of the oesophagogastric junction.
The aim of our study was to compare the relative lifetime costs and clinical results of the Nd:YAG laser to those of SEMS as alternative forms of primary palliation of dysphagia for adenocarcinoma near the oesophagogastric junction.

Methods:Fifty-two patients with distal oesophageal or oesophagogastric adenocarcinomas underwent palliative treatment for dysphagia: 32 treated with laser therapy and 20 with SEMS in this retrospective study.
The clinical outcome and real cumulative costs as physical units and in financial terms were analysed for these study groups.

Results: Although patients palliated with SEMS underwent fewer procedures (1.9±1.6 vs 3.4±4.0, P=0.0048) and spent less time in endoscopic theatre (38±25 min vs 118±152 min, P=0.0048), they spent as many days in hospital (12.9 vs 15.1, P=0.370) and required as high overall costs for therapy (5360 EUR vs 5450 EUR, P=0.679) as those treated with laser therapy. In addition, they had higher morbidity rates (30 vs 6.3%, P=0.043), hospital mortality (20 vs 3.1%, P=0.066), and 30-day mortality (40 vs 3.1%, P=0.0011) than did patients with laser therapy, with no evidence of SEMS being the more effective treatment modality.

Conclusions: In patients with adenocarcinoma at the distal oesophagus or at the oesophagogastric junction, laser therapy palliates dysphagia effectively with lower morbidity and mortality rates and without increased costs or hospital stays than does use of self-expanding metallic stents.

Original languageEnglish
Pages (from-to)711-715
JournalEuropean Journal of Surgical Oncology
Volume28
Issue number7
DOIs
Publication statusPublished - 2002
MoE publication typeA1 Journal article-refereed

Fingerprint

Laser Coagulation
Esophagogastric Junction
Laser Therapy
Stents
Adenocarcinoma
Costs and Cost Analysis
Deglutition Disorders
Morbidity
Mortality
Solid-State Lasers
Hospital Mortality
Palliative Care
Esophagus
Clinical Studies
Length of Stay
Therapeutics
Retrospective Studies

Keywords

  • cost analysis
  • inoperable adenocarcinoma
  • laser coagulation
  • oesophagogastric junction
  • self-expanding metallic stents

Cite this

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title = "Inoperable adenocarcinoma of the oesophagogastric junction: A comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis",
abstract = "Aims: Neither clinical nor financial comparisons yet exist between self-expanding metallic stents (SEMS) and laser therapy, concentrating on the treatment of obstructive adenocarcinomas of the oesophagogastric junction. The aim of our study was to compare the relative lifetime costs and clinical results of the Nd:YAG laser to those of SEMS as alternative forms of primary palliation of dysphagia for adenocarcinoma near the oesophagogastric junction.Methods:Fifty-two patients with distal oesophageal or oesophagogastric adenocarcinomas underwent palliative treatment for dysphagia: 32 treated with laser therapy and 20 with SEMS in this retrospective study. The clinical outcome and real cumulative costs as physical units and in financial terms were analysed for these study groups.Results: Although patients palliated with SEMS underwent fewer procedures (1.9±1.6 vs 3.4±4.0, P=0.0048) and spent less time in endoscopic theatre (38±25 min vs 118±152 min, P=0.0048), they spent as many days in hospital (12.9 vs 15.1, P=0.370) and required as high overall costs for therapy (5360 EUR vs 5450 EUR, P=0.679) as those treated with laser therapy. In addition, they had higher morbidity rates (30 vs 6.3{\%}, P=0.043), hospital mortality (20 vs 3.1{\%}, P=0.066), and 30-day mortality (40 vs 3.1{\%}, P=0.0011) than did patients with laser therapy, with no evidence of SEMS being the more effective treatment modality.Conclusions: In patients with adenocarcinoma at the distal oesophagus or at the oesophagogastric junction, laser therapy palliates dysphagia effectively with lower morbidity and mortality rates and without increased costs or hospital stays than does use of self-expanding metallic stents.",
keywords = "cost analysis, inoperable adenocarcinoma, laser coagulation, oesophagogastric junction, self-expanding metallic stents",
author = "E.I.T. Sihvo and Tuomo Pentik{\"a}inen and M.E. Luostarinen and O.J. R{\"a}m{\"o} and J.A. Salo",
year = "2002",
doi = "10.1053/ejso.2002.1315",
language = "English",
volume = "28",
pages = "711--715",
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Inoperable adenocarcinoma of the oesophagogastric junction : A comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis. / Sihvo, E.I.T.; Pentikäinen, Tuomo; Luostarinen, M.E.; Rämö, O.J.; Salo, J.A.

In: European Journal of Surgical Oncology, Vol. 28, No. 7, 2002, p. 711-715.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Inoperable adenocarcinoma of the oesophagogastric junction

T2 - A comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis

AU - Sihvo, E.I.T.

AU - Pentikäinen, Tuomo

AU - Luostarinen, M.E.

AU - Rämö, O.J.

AU - Salo, J.A.

PY - 2002

Y1 - 2002

N2 - Aims: Neither clinical nor financial comparisons yet exist between self-expanding metallic stents (SEMS) and laser therapy, concentrating on the treatment of obstructive adenocarcinomas of the oesophagogastric junction. The aim of our study was to compare the relative lifetime costs and clinical results of the Nd:YAG laser to those of SEMS as alternative forms of primary palliation of dysphagia for adenocarcinoma near the oesophagogastric junction.Methods:Fifty-two patients with distal oesophageal or oesophagogastric adenocarcinomas underwent palliative treatment for dysphagia: 32 treated with laser therapy and 20 with SEMS in this retrospective study. The clinical outcome and real cumulative costs as physical units and in financial terms were analysed for these study groups.Results: Although patients palliated with SEMS underwent fewer procedures (1.9±1.6 vs 3.4±4.0, P=0.0048) and spent less time in endoscopic theatre (38±25 min vs 118±152 min, P=0.0048), they spent as many days in hospital (12.9 vs 15.1, P=0.370) and required as high overall costs for therapy (5360 EUR vs 5450 EUR, P=0.679) as those treated with laser therapy. In addition, they had higher morbidity rates (30 vs 6.3%, P=0.043), hospital mortality (20 vs 3.1%, P=0.066), and 30-day mortality (40 vs 3.1%, P=0.0011) than did patients with laser therapy, with no evidence of SEMS being the more effective treatment modality.Conclusions: In patients with adenocarcinoma at the distal oesophagus or at the oesophagogastric junction, laser therapy palliates dysphagia effectively with lower morbidity and mortality rates and without increased costs or hospital stays than does use of self-expanding metallic stents.

AB - Aims: Neither clinical nor financial comparisons yet exist between self-expanding metallic stents (SEMS) and laser therapy, concentrating on the treatment of obstructive adenocarcinomas of the oesophagogastric junction. The aim of our study was to compare the relative lifetime costs and clinical results of the Nd:YAG laser to those of SEMS as alternative forms of primary palliation of dysphagia for adenocarcinoma near the oesophagogastric junction.Methods:Fifty-two patients with distal oesophageal or oesophagogastric adenocarcinomas underwent palliative treatment for dysphagia: 32 treated with laser therapy and 20 with SEMS in this retrospective study. The clinical outcome and real cumulative costs as physical units and in financial terms were analysed for these study groups.Results: Although patients palliated with SEMS underwent fewer procedures (1.9±1.6 vs 3.4±4.0, P=0.0048) and spent less time in endoscopic theatre (38±25 min vs 118±152 min, P=0.0048), they spent as many days in hospital (12.9 vs 15.1, P=0.370) and required as high overall costs for therapy (5360 EUR vs 5450 EUR, P=0.679) as those treated with laser therapy. In addition, they had higher morbidity rates (30 vs 6.3%, P=0.043), hospital mortality (20 vs 3.1%, P=0.066), and 30-day mortality (40 vs 3.1%, P=0.0011) than did patients with laser therapy, with no evidence of SEMS being the more effective treatment modality.Conclusions: In patients with adenocarcinoma at the distal oesophagus or at the oesophagogastric junction, laser therapy palliates dysphagia effectively with lower morbidity and mortality rates and without increased costs or hospital stays than does use of self-expanding metallic stents.

KW - cost analysis

KW - inoperable adenocarcinoma

KW - laser coagulation

KW - oesophagogastric junction

KW - self-expanding metallic stents

U2 - 10.1053/ejso.2002.1315

DO - 10.1053/ejso.2002.1315

M3 - Article

VL - 28

SP - 711

EP - 715

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

IS - 7

ER -