Clinical implications of esophagorespiratory fistulae in patients with esophageal squamous cell carcinoma (SCCA)

In this retrospective study, we investigated the incidence of esophagorespiratory fistula (ERF) in esophageal squamous cell carcinomas, clinical characteristics and outcomes of esophageal cancer patient with ERF, and effective therapeutic options. From 1998 to 2007, 1,095 patients with squamous cell carcinomas of the esophagus were treated at Samsung Medical Center. A comprehensive retrospective review of all these patients with clinical data of ERF was performed. The incidence of ERF in patients with esophageal cancer was 4.7% (52/1095). Comparing with the patients without ERF, the patients with ERF presented with a more advanced stage of disease, more frequent involvement of upper-mid thoracic esophagus, a longer segment of the tumor, and more initial airway involvement. The median time from the diagnosis of esophageal cancer to the development of a fistula was 7.9 months. ERF could be divided into three different categories according to the causes; (1) ERF associated with complication of the cancer progression (65.4%), (2) ERF related with treatments (28.8%), (3) ERF with mixed causes (5.8%). Four patients (8%) received radiation therapy, and nine patients (17%) underwent surgery to treat the ERF. Many of the patients with ERF were palliated with esophageal stent (40%) and/or gastrostomy (38%). The median survival time after diagnosis of the ERF was 8.0 weeks. An ERF resulting from esophageal cancer entails a poor prognosis in spite of supportive and/or definitive treatment. More comprehensive approach to improve the course of ERF and active supportive care, which can prevent complication from leakage, should be developed.