Are single or dual luminal covered expandable metallic stents suitable for esophageal squamous cell carcinoma with esophago-airway fistula?

BACKGROUND: To analyze the outcomes of single or dual luminal self-expandable covered metallic stents (SECMS) for palliative treatment for esophageal cancer with esophago-airway fistula (EAF).

METHODS: We retrospectively assessed 50 patients who underwent SECMS placement for malignant EAF at our institution between June 2005 and December 2014 to define clinical results of stenting. Treatment provided was classified into initial single airway, single esophageal, or double stent placement. Independent associations between size, location of the EAF, patient's condition, and the risk of migration or reopening with the different types of stenting were examined using logistic regression analysis.

RESULTS: The final management of malignant EAF was esophageal stent in 21 patients, airway stent in 13, and dual stents in 16. No patients failed stenting. During a median follow-up of 178 days (range 1-893 days), the fistula reopened in 33 (66 %) of 50 patients. No factors, including fistula size, location, or initial selection of single or dual stenting, were correlated with reopening. Nineteen (57.6 %) of 33 patients needed restenting, and the reopened EAF was sealed off successfully in 52.6 % of new stent placements. The clinical failure of EAF closure was correlated only with proximal dilated esophagus (p = 0.013). Mean survival in patients with clinical success of EAF closure was also significantly longer than that in patients with clinical failure (242.0 vs. 80.1 days, p < 0.001). KPS (p = 0.026), cough ability (p = 0.004), successful closure of EAF (p = 0.001), and reopening (p = 0.007) all had significant effects on survival.

CONCLUSIONS: We conclude that SECMS is safe and effective in the palliation of esophageal cancer with malignant EAF, especially in patients with an otherwise excellent general condition. Other modalities of management are recommended for malignant EAF with proximal dilation of the esophagus.