title: Recurrent oesophageal cancer complicated by tracheo-oesophageal fistula: improved palliation by means of parallel tracheal and oesophageal stenting.
abstract: OBJECTIVE
  Recurrent oesophageal carcinoma complicated by the development of a tracheo-oesophageal fistula is a crushing condition. In this situation, endoscopic double stenting may provide a quick and safe option for palliation.
  
  
  METHODS
  The outcomes of patients who received endoscopic parallel stent implantation for tracheo-oesophageal fistula due to recurrent oesophageal cancer at a German tertiary referral hospital between 2006 and 2013 were reviewed in a retrospective case study.
  
  
  RESULTS
  A total of 9 patients were identified (mean age 59.9 years). Tumour entity was squamous cell carcinoma, adenocarcinoma and neuroendocrine cancer of the oesophagus in 5, 3 and 1 case, respectively. The mean interval between primary treatment and recurrence was 19.2 months. Successful double-stent placement was always feasible. Complete closure of the communication between oesophagus and respiratory system was accomplished in all cases by stent implantation. There were no stent-associated complications. The mean survival following stent insertion was 64 days (6-121 days). After successful double stenting, 5 patients were fit enough to receive palliative chemo- or radiotherapy. Seven patients were finally discharged home after adequate oral intake had been achieved. Fatal aspiration pneumonia with respiratory failure occurred in 2 cases.
  
  
  CONCLUSIONS
  Endoscopic parallel stent implantation provides an easy and ubiquitous available technique for closure and palliation of tracheo-oesophageal fistula caused by recurrent oesophageal cancer. Immediate sealing of the fistula and relief of symptoms related to aspiration is achieved while hazardous operations are avoided. Therefore, we recommend endoscopic parallel stent insertion as the treatment of choice in case of tracheo-oesophageal fistula caused by recurrent oesophageal cancer.
authors.affiliation: Department of General and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schweigert
authors.forename: Maria
authors.initials: M
authors.lastname: Posada-González
authors.forename: Attila
authors.initials: A
authors.lastname: Dubecz
authors.forename: Dietmar
authors.initials: D
authors.lastname: Ofner
authors.forename: Herbert
authors.initials: H
authors.lastname: Muschweck
authors.forename: Hubert J
authors.initials: HJ
authors.lastname: Stein
mesh_terms: D001999:Bronchoscopy; D002277:Carcinoma / Q000150:complications* / Q000401:mortality / Q000473:pathology; D003679:Deglutition; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D020127:Recovery of Function; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: Endoscopic stent; Oesophageal carcinoma; Palliative care; Tracheobronchial fistula