Manegment of malignant esophagorespiratory fistula

The development of a malignant esophagorespiratory fistula is a devasting complication. The only effective treatment is to exclude the fistula from the alimentary tract. This may be achieved by intubation or esophageal bypass, and we describe our experience with these two procedures. To assess the results of therapy, we reviewed our experience in 8 patients with esophagorespiratory fistula due to esophageal carcinoma from 1994 to 2002 at Omid and Ghaem Hospitals. Age ranged from 45 to 73 years [median 57.7 years] the male / female ratio was 3:1. Primary tumor site was squamous cell carcinoma of midesophagus in all patients. All patients experienced an approximately equal average weight loss of 10kg. Three patients were intubated by a traction [pull-through] technique with plastic stent named Mousseau-Barbin tube and the other five patients were treated by substernal gastric bypass of the excluded esophagus. There was one cervical anastomotic leak in the bypass group that healed conservatively and also one hospital death in the bypass group [hospital mortality rate 20%]. Due to pulmonary infection, with no hospital death in the intubated group. The mean hospital stay in the intubation group was 13 days and in the bypass group was 19 days. All patients in both groups had acceptable quality of remaining life and were able to eat soft or regular diet without any serious pulmonary complications. The mean survival in the intubated group was 125.5 days [range 105 to 145 days] and in bypass group 137.5 days [75 to 180 days]