Affiliation:
1. Department of Respiratory and Critical Care Medicine The Affiliated Hospital of Southwest Medical University Luzhou China
2. Department of Respiratory and Critical Care Medicine The People's Hospital of Leshan Leshan China
3. Department of Critical Care Medicine Meishan Traditional Chinese Medical Hospital Meishan China
4. Department of Respiratory and Critical Care Medicine West China Hospital of Sichuan University Chengdu China
5. Department of Critical Care Medicine Sichuan Cancer Hospital Chengdu China
Abstract
AbstractIntroductionWhether airway‐compromised airway–esophageal fistula (AEF) patients should undergo combined airway and esophageal stenting is controversial. This study was designed to evaluate the survival prognosis and poststent interventions in AEF patients with airways compromised by advanced malignancy with or without airway stents.MethodsA retrospective analysis of the medical records, survival times, and poststent interventions of 17 patients with or without airway stents was performed.ResultsThe causes of AEF were esophageal cancer (11/17, 64.7%), lung cancer (6/17, 29.4%), and thyroid cancer (1/17, 5.9%). All patients received a nasogastric tube (n = 12) or underwent gastrostomy (n = 5) to resume enteral nutrition. Thirteen patients underwent airway stent insertion (13/17, 76.5%), whereas four patients did not. Four patients with a high risk of stent migration received external stent fixation to the trachea. Three of the patients with stents suffered severe granulation tissue formation and needed repeated bronchoscopy interventions. In the stented group, none of the patients developed stent migration, and the overall median survival time was 9 months, compared with 1.25 months in the nonstented group (P = 0.04). Cox proportional hazards regression revealed that stent insertion, nasogastric tube insertion, and transcatheter bronchial artery chemoembolization were protective factors against death, whereas surgery‐related fistula, fistula larger than 2 cm, continued chemotherapy, and age were risk factors for poor survival (P < 0.05).ConclusionIn airway‐compromised AEF patients, airway stents and nasogastric tubes are probably the preferred treatments. Airway stenting is tolerable, and routine weekly poststent bronchoscopy is needed in the first month and depending on respiratory symptoms thereafter.