All Title Author
Keywords Abstract

PLOS ONE  2012 

Comparative Study of Esophageal Stent and Feeding Gastrostomy/Jejunostomy for Tracheoesophageal Fistula Caused by Esophageal Squamous Cell Carcinoma

DOI: 10.1371/journal.pone.0042766

Full-Text   Cite this paper   Add to My Lib

Abstract:

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.

References

[1]  Balazs A, Kupcsulik PK, Galambos Z (2008) Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg 34: 1103–1107.
[2]  Martini N, Goodner JT, D’Angio GJ, Beattie EJ Jr (1970) Tracheoesophageal fistula due to cancer. J Thorac Cardiovasc Surg 59: 319–324.
[3]  Morgan RA, Ellul JP, Denton ER, Glynos M, Mason RC, et al. (1997) Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses. Radiology 204: 527–532.
[4]  Gudovsky LM, Koroleva NS, Biryukov YB, Chernousov AF, Perelman MI (1993) Tracheoesophageal fistulas. Ann Thorac Surg 55: 868–875.
[5]  Hu Y, Zhao YF, Chen LQ, Zhu ZJ, Liu LX, et al. (2009) Comparative study of different treatments for malignant tracheoesophageal/bronchoesophageal fistulae. Dis Esophagus 22: 526–531.
[6]  Burt M, Diehl W, Martini N, Bains MS, Ginsberg RJ, et al.. (1991) Malignant esophagorespiratory fistula: management options and survival. Ann Thorac Surg 52: 1222–1228; discussion 1228–1229.
[7]  Margolis M, Alexander P, Trachiotis GD, Gharagozloo F, Lipman T (2003) Percutaneous endoscopic gastrostomy before multimodality therapy in patients with esophageal cancer. Ann Thorac Surg 76: 1694–1697; discussion 1697–1698.
[8]  Spivak H, Katariya K, Lo AY, Harvey JC (1996) Malignant tracheo-esophageal fistula: use of esophageal endoprosthesis. J Surg Oncol 63: 65–70.
[9]  Choi MK, Park YH, Hong JY, Park HC, Ahn YC, et al. (2010) Clinical implications of esophagorespiratory fistulae in patients with esophageal squamous cell carcinoma (SCCA). Med Oncol 27: 1234–1238.
[10]  Lolley DM, Ray JF, Ransdell HT, Razzuk MA, Urschel HC (1978) Management of malignant esophagorespiratory fistula. Ann Thorac Surg 25: 516–520.
[11]  Shin JH, Song HY, Ko GY, Lim JO, Yoon HK, et al. (2004) Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 232: 252–259.
[12]  Tomaselli F, Maier A, Sankin O, Woltsche M, Pinter H, et al. (2001) Successful endoscopical sealing of malignant esophageotracheal fistulae by using a covered self-expandable stenting system. Eur J Cardiothorac Surg 20: 734–738.
[13]  Weigert N, Neuhaus H, Rosch T, Hoffmann W, Dittler HJ, et al. (1995) Treatment of esophagorespiratory fistulas with silicone-coated self-expanding metal stents. Gastrointest Endosc 41: 490–496.
[14]  Talreja JP, Eloubeidi MA, Sauer BG, Al-Awabdy BS, Lopes T, et al.. (2011) Fully covered removable nitinol self-expandable metal stents (SEMS) in malignant strictures of the esophagus: a multicenter analysis. Surg Endosc.
[15]  Low DE, Kozarek RA (2003) Removal of esophageal expandable metal stents: description of technique and review of potential applications. Surg Endosc 17: 990–996.
[16]  Balazs A, Galambos Z, Kupcsulik PK (2009) Characteristics of esophagorespiratory fistulas resulting from esophageal cancers: a single-center study on 243 cases in a 20-year period. World J Surg 33: 994–1001.
[17]  Nomori H, Horio H, Imazu Y, Suemasu K (2000) Double stenting for esophageal and tracheobronchial stenoses. Ann Thorac Surg 70: 1803–1807.
[18]  Paganin F, Schouler L, Cuissard L, Noel JB, Becquart JP, et al. (2008) Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement. PLoS One 3: e3101.
[19]  Siersema PD, Hop WC, Dees J, Tilanus HW, van Blankenstein M (1998) Coated self-expanding metal stents versus latex prostheses for esophagogastric cancer with special reference to prior radiation and chemotherapy: a controlled, prospective study. Gastrointest Endosc 47: 113–120.
[20]  Lazaraki G, Katsinelos P, Nakos A, Chatzimavroudis G, Pilpilidis I, et al. (2011) Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study. Surg Endosc 25: 628–635.
[21]  Freitag L, Tekolf E, Steveling H, Donovan TJ, Stamatis G (1996) Management of malignant esophagotracheal fistulas with airway stenting and double stenting. Chest 110: 1155–1160.
[22]  Siewert JR, Ott K (2007) Are squamous and adenocarcinomas of the esophagus the same disease? Semin Radiat Oncol 17: 38–44.
[23]  Siddiqui AA, Glynn C, Loren D, Kowalski T (2009) Self-expanding plastic esophageal stents versus jejunostomy tubes for the maintenance of nutrition during neoadjuvant chemoradiation therapy in patients with esophageal cancer: a retrospective study. Dis Esophagus 22: 216–222.
[24]  May A, Hahn EG, Ell C (1996) Self-expanding metal stents for palliation of malignant obstruction in the upper gastrointestinal tract. Comparative assessment of three stent types implemented in 96 implantations. J Clin Gastroenterol 22: 261–266.
[25]  Low DE, Kozarek RA (1998) Comparison of conventional and wire mesh expandable prostheses and surgical bypass in patients with malignant esophagorespiratory fistulas. Ann Thorac Surg 65: 919–923.

Full-Text

comments powered by Disqus