Comparative study of esophageal stent and feeding gastrostomy/jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma.
BACKGROUND
A malignant tracheoesophageal/bronchoesophageal fistula (TEF) is a life-threatening complication of esophageal squamous cell carcinoma. A feeding gastrostomy/jejunostomy had been the most common treatment method for patients with TEF before the era of stenting. The aim of this retrospective study is to compare the prognosis of esophageal squamous cell carcinoma patients with TEF treated with an esophageal metallic stent to those treated with a feeding gastrostomy/jejunostomy.


METHODS
We retrospectively reviewed a total of 1011 patients with esophageal squamous cell carcinoma between 1996 and 2011 at Kaohsiung Chang Gung Memorial Hospital, and 86 patients with TEF (8.5%) were identified. The overall survival and other clinical data were compared between 30 patients treated with an esophageal metallic stent and 35 patients treated with a feeding gastrostomy/jejunostomy.


RESULTS
Among the 65 patients receiving either an esophageal metallic stent or a feeding gastrostomy/jejunostomy, univariate analysis showed that treatment modality with an esophageal metallic stent (P = 0.007) and radiotherapy treatment after fistula diagnosis (P = 0.04) were predictive of superior overall survival. In the multivariate comparison, treatment modality with an esophageal metallic stent (P = 0.026, odds ratio: 1.859) represented the independent predictive factor of superior overall survival. There were no significant differences between groups in mean decrease in serum albumin or mean body weight loss. Compared to the feeding gastrostomy/jejunostomy group, a significantly higher proportion of patients in the stenting group (53% versus 14%, P = 0.001) were able to receive chemotherapy within 30 days after fistula diagnosis, indicating better infection control in the stenting group.


CONCLUSIONS
Compared with a feeding gastrostomy/jejunostomy, an esophageal metallic stent significantly improves overall survival in patients with malignant TEF in our retrospective analysis. Esophageal metallic stent placement may be considered the first-line of treatment for patients with malignant TEF.
Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Yen-Hao
YH
Chen
Shau-Hsuan
SH
Li
Yi-Chun
YC
Chiu
Hung-I
HI
Lu
Cheng-Hua
CH
Huang
Kun-Ming
KM
Rau
Chien-Ting
CT
Liu
D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology*; D004947:Esophagus / Q000601:surgery*; D005248:Feeding Methods / Q000009:adverse effects; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects; D008670:Metals; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D014138:Tracheoesophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
D008670:Metals