Palliation of malignant aerodigestive fistulae with self-expanding metallic stents.
Malignant aerodigestive fistulae are rare but devastating sequelae of thoracic cancers, most commonly associated with esophageal cancer. Survival following development of a malignant aerodigestive fistula is measured in weeks. Palliation is the primary goal of therapy and to this end, we report the use of self-expanding metallic stents (SEMS) as treatment. Between May 1999 and January 2004, 12 patients were treated for malignant aerodigestive fistulae. The underlying diagnosis was esophageal cancer for 10 patients, and non-small cell lung cancer for two others. All patients were symptomatic and fistulae were diagnosed by esophagoscopy in seven, bronchoscopy in two, and esophagram in three. Seven covered Wallstents (seven esophageal) and eight covered Ultraflex (five tracheal and three esophageal) were used. A single stent was placed in eight patients (seven esophageal and one tracheal). Three patients required esophageal and tracheal stents and one patient needed two tracheal stents. General anesthesia was required in 50% of the patients. There were no procedure-related complications. Symptoms were palliated in 100% of patients and oral intake was reinstituted in 42% (5/12). All the patients were discharged from hospital after SEMS placement and one patient returned for an uneventful tracheal stent replacement secondary to mucus impaction 2 months later. SEMS placement is an effective strategy to palliate malignant aerodigestive fistulae. Complications are rare and symptoms are alleviated in most patients.
Murthy
S
S
Center for Major Airway Diseases, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. murthys1@ccf.org
Gonzalez-Stawinski
G V
GV
Rozas
M S
MS
Gildea
T R
TR
Dumot
J A
JA
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications; D020099:Coated Materials, Biocompatible; D016154:Digestive System Fistula / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D014132:Trachea / Q000601:surgery; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible