A comparison of laser photoablation and mesh stenting in the palliation of oesophageal cancer

Most oesophageal tumors are inoperable at diagnosis. The optimal modlaity of endoscopic palliation is currently uncertain. We aimed to compare the palliation achieved by laser (n-Yag) photo-ablative therapy or expandable mesh stenting (Microvasive Ultraflex^R) in 50 consecutive patients treated at this unit between 1992 and 1995. (laser =23, mesh =27). Survival analysis was by Kaplan-Meier method. The mean survival was 25 weeks, (a = 24, range 1-105). Both groups reported satisfactory relief of dysphagia after treatment. There was a trend towards improved survival in the laser group (p=.07, Log Rank test) and in all patients that did not have metastatio disease at diagnosis (p=.01,Log Rank test). Age, sex, provision of adjuvant therapy, tumor type or site had no influence on survival. The laser group required significantly more after-care interventions to maintain deglutition. (p=.003, Mann Whitney U Test) at a mean cost, excess of $73. There were more initial complications in the stent group but this difference was not significant. The cost of palliation was significantly greater in the laser group. We conclude that although laser therapy is marginally superior in terms of survival the excess after-care provision mitigates this advantage.