University of Oulu

Helminen, O., Sihvo, E., Helmiö, M. et al. Preoperative Esophageal Stenting and 5-Year Survival in Patients Undergoing Esophagectomy for Esophageal Cancer: a Population-Based Nationwide Study from Finland. J Gastrointest Surg 27, 1078–1088 (2023).

Preoperative esophageal stenting and 5-year survival in patients undergoing esophagectomy for esophageal cancer : a population-based nationwide study from Finland

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Author: Helminen, Olli1,2; Sihvo, Eero3; Helmiö, Mika4;
Organizations: 1Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
2Department of Surgery, Oulu University Hospital, Kajaaninkatu 50, 90220, Oulu, Finland
3Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
4Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
5Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
6Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
7Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
8Department of Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
9Department of Pathology and HUSLAB, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
10Applied Tumor Genomics Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
11Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
12Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, University of Tampere, Tampere, Finland
13Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
14Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Springer Nature, 2023
Publish Date: 2023-10-20


Background: Preoperative esophageal stenting is proposed to have a negative effect on outcomes. The aim was to compare a 5-year survival in patients undergoing esophagectomy for esophageal cancer with and without preoperative esophageal stent in a population-based nationwide cohort from Finland. The secondary outcome was 90-day mortality.

Methods: This study included curatively intended esophagectomies for esophageal cancer in Finland between 1999 and 2016, with follow-up until December 31, 2019. Cox proportional hazards models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of overall 5-year and 90-day mortality. Model 1 was adjusted for age, sex, year of the surgery, comorbidities, histology, pathological stage, and neoadjuvant therapy. Model 2 included also albumin level and BMI.

Result: Of 1064 patients, a total of 134 patients underwent preoperative stenting and 930 did not. In both adjusted models 1 and 2, higher 5-year mortality was seen in patients with preoperative stent with HRs of 1.29 (95% CI 1.00–1.65) and 1.25 (95% CI 0.97–1.62), respectively, compared to no stenting. The adjusted HR of 90-day mortality was 2.49 (95% CI 1.27–4.87) in model 1 and 2.49 (95% CI 1.25–4.99) in model 2. When including only neoadjuvant-treated patients, those with preoperative stent had a 5-year survival of 39.2% compared to 46.4% without stent (adjusted HR 1.34, 95% CI 1.00–1.80), and a 90-day mortality rate of 8.5% and 2.5% (adjusted HR 3.99, 95% CI 1.51–10.50).

Discussion: This nationwide study reports worse 5-year and 90-day outcomes in patients with preoperative esophageal stent. Since residual confounding remains possible, observed difference could be only an association rather than the cause.

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Series: Journal of gastrointestinal surgery
ISSN: 1091-255X
ISSN-E: 1873-4626
ISSN-L: 1091-255X
Volume: 27
Issue: 6
Pages: 1078 - 1088
DOI: 10.1007/s11605-023-05643-7
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
Funding: Open Access funding provided by University of Oulu including Oulu University Hospital. This study was funded by the Instrumentarium Science Foundation (O. H.), Finnish State Research Funding (O. H.), Georg C. and Mary Ehrnrooth Foundation (O. H.), Finnish Cancer Foundation (J. H. K.), Päivikki and Sakari Sohlberg Foundation (J. H. K.), and Sigrid Juselius Foundation (J. H. K.).
Copyright information: © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit