Enigma of Esophageal - Respiratory Fistula in Advanced Esophageal Cancer
Abstract
Background: The incidence of malignant esophageal-respiratory fistulas in esophageal cancer patients is not so frequent. The fistula development in esophageal cancer may be due to advanced disease or a radiotherapy-related complication. Rarely, a pulmonary abscess may develop, which is the most dreadful complication resulting in dismal outcomes. Here, we reported 2-cases of esophageal-respiratory fistula; one withesophageal bronchial fistula and the other with esophageal pleural fistula. Case reports: A 46-year-aged man presented with complaints of difficulty in swallowing for 4 months. CECT chest showed an esophageal growth of 8.5 cm in the lower esophagus. The patient received palliative radiotherapy followed by palliative chemotherapy and showed some improvement in dysphagia.Nine months after the start of treatment, the patient’s dysphagia began to worsen, and he was put on oral metronomic chemotherapy. After 1-year of metronomic chemotherapy, the patient developed cough and chest pain and was diagnosed with an esophageal-pleural fistula with chest wall collection and pleural effusion. The patient was managed conservatively and later lost to follow-up. Another 65-year-old patient presented with dysphagia for 3-months. CECT chest showed an esophageal growth of 5.5 cm in the middle esophagus.The patient received palliative radiotherapy, after which the dysphagia improved. In 3rd month of follow up patient’s dysphagia worsened; barium swallow showed esophageal- bronchial fistula. The patient was managed symptomatically and later lost to follow-up.Conclusions: Fistula formation and subsequent abscess results in a poor prognosis.With advancing disease and compromised general condition of the patient, palliation of symptoms is a significant challenge. Treatment becomes difficult due to the rare occurrence of fistulas and the non-standardization of the treatment protocol. Invasive treatment includes esophageal-pulmonary resection, endoscopic placement of self-expandablecovered stents, drainage of empyema and obliteration of empyema cavity, esophageal diversion, and non-invasive treatment includes best supportive care. However, even with appropriate treatment, the outcome is dismal.
1. Duranceau A, Jamieson GG. Malignant tracheoesophageal fistula. Ann Thorac Surg. 1984;37:346-54.
2. Fitzgerald RH Jr, Bartels DM, Parker EF. Tracheoesophageal fistulas secondary to carcinoma of the esophagus. J Thorac Cardiovasc Surg 1981;82:194-7.
3. Martini N, Goodner JT, D'Angio GJ et al. Tracheoesophageal fistula due to cancer. J Thorac Cardiovasc Surg. 1970;59:319-24.
4. Angorn IB. Intubation in the treatment of carcinoma of the esophagus. World J Surg. 1981;5:535-41.
5. Cong Z, Diao, Q, Yi J et al. Esophagectomy combined with aortic segment replacement for esophageal cancer invading the aorta. Ann Thorac Surg. 2014;97(2):460-6.
6. Kosugi S, Ichikawa H, Kanda T et al. Clinico-pathological characteristics and prognosis of patients with esophageal carcinoma invading adjacent structures found during esophagectomy. J Surg Oncol. 2012;105:767-72.
7. Chuah BY, Khoo KL, Khor CJ. Clinical challenges and images in GI. Esophago?pleural fistula. Gastroenterology. 2008;134:919,1275.
8. Chao Zhu, Songping Wang, Yunhong you et al. Risk Factors for Esophageal Fistula in Esophageal Cancer Patients Treated with Radiotherapy: A Systematic Review and Meta-Analysis. Oncol Res Treat. 2020;43:34-40.
9. Burt M, Diehl W, Martini N et al. Malignant Esophagorespiratory fistula: management options and survival. Ann Thorac Surg. 1991;52(6):1222-8.
10. Tae-Hyung Kim, Ji Hoon Shin, Kyung Rae Kim et al. Treatment of Esophagopleural Fistulas Using Covered Retrievable Expandable Metallic Stents. J Vasc Interv Radiol. 2014;25:623-9.
11. Alexander Rehders, Billur Baseras, Leila Telan. Esophageal cancer complicated by esophagopulmonary fistula and lung abscess formation: A surgical approach. Thoracic Cancer 2014;(5):468-71.
12. Xin Guan, Chao Liu, Tianshuo Zhou et al. Survival and prognostic factors of patients with esophageal fistula in advanced esophageal squamous cell carcinoma. Bioscience Reports. (2020) 40 BSR20193379.
13. M. Davydov, I. Stilidi, V. Bokhyan et al. Surgical treatment of esophageal carcinoma complicated by fistulas. European Journal of Cardio-thoracic Surgery. 2001;20:405-8.
14. Yang Zhang, Zongjuan Li, Wei Zhang et al. Risk factors for esophageal fistula in patients with locally advanced esophageal carcinoma receiving chemoradiotherapy. OncoTargets and Therapy. 2018;11:2311-7.
15. Schweigert M, Dubecz A, beronm et al. Surgical therapy for necrotizing pneumonia and lung Gangrene. Thorac Cardiovasc Surg. 2013;61:636-41.
16. Tsai YF, Ku YH. Necrotizing pneumonia: a rare complication Of pneumonia requiring special consideration. Curr Opin Pulmmed. 2012; 18:246-52.
17.Werner-Wasik M, Yorke E, Deasy J, Nam J, Marks LB. Radiation dose-volume effects in the esophagus.
Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl): S86-93.
2. Fitzgerald RH Jr, Bartels DM, Parker EF. Tracheoesophageal fistulas secondary to carcinoma of the esophagus. J Thorac Cardiovasc Surg 1981;82:194-7.
3. Martini N, Goodner JT, D'Angio GJ et al. Tracheoesophageal fistula due to cancer. J Thorac Cardiovasc Surg. 1970;59:319-24.
4. Angorn IB. Intubation in the treatment of carcinoma of the esophagus. World J Surg. 1981;5:535-41.
5. Cong Z, Diao, Q, Yi J et al. Esophagectomy combined with aortic segment replacement for esophageal cancer invading the aorta. Ann Thorac Surg. 2014;97(2):460-6.
6. Kosugi S, Ichikawa H, Kanda T et al. Clinico-pathological characteristics and prognosis of patients with esophageal carcinoma invading adjacent structures found during esophagectomy. J Surg Oncol. 2012;105:767-72.
7. Chuah BY, Khoo KL, Khor CJ. Clinical challenges and images in GI. Esophago?pleural fistula. Gastroenterology. 2008;134:919,1275.
8. Chao Zhu, Songping Wang, Yunhong you et al. Risk Factors for Esophageal Fistula in Esophageal Cancer Patients Treated with Radiotherapy: A Systematic Review and Meta-Analysis. Oncol Res Treat. 2020;43:34-40.
9. Burt M, Diehl W, Martini N et al. Malignant Esophagorespiratory fistula: management options and survival. Ann Thorac Surg. 1991;52(6):1222-8.
10. Tae-Hyung Kim, Ji Hoon Shin, Kyung Rae Kim et al. Treatment of Esophagopleural Fistulas Using Covered Retrievable Expandable Metallic Stents. J Vasc Interv Radiol. 2014;25:623-9.
11. Alexander Rehders, Billur Baseras, Leila Telan. Esophageal cancer complicated by esophagopulmonary fistula and lung abscess formation: A surgical approach. Thoracic Cancer 2014;(5):468-71.
12. Xin Guan, Chao Liu, Tianshuo Zhou et al. Survival and prognostic factors of patients with esophageal fistula in advanced esophageal squamous cell carcinoma. Bioscience Reports. (2020) 40 BSR20193379.
13. M. Davydov, I. Stilidi, V. Bokhyan et al. Surgical treatment of esophageal carcinoma complicated by fistulas. European Journal of Cardio-thoracic Surgery. 2001;20:405-8.
14. Yang Zhang, Zongjuan Li, Wei Zhang et al. Risk factors for esophageal fistula in patients with locally advanced esophageal carcinoma receiving chemoradiotherapy. OncoTargets and Therapy. 2018;11:2311-7.
15. Schweigert M, Dubecz A, beronm et al. Surgical therapy for necrotizing pneumonia and lung Gangrene. Thorac Cardiovasc Surg. 2013;61:636-41.
16. Tsai YF, Ku YH. Necrotizing pneumonia: a rare complication Of pneumonia requiring special consideration. Curr Opin Pulmmed. 2012; 18:246-52.
17.Werner-Wasik M, Yorke E, Deasy J, Nam J, Marks LB. Radiation dose-volume effects in the esophagus.
Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl): S86-93.
| Files | ||
| Issue | Vol 13 No 4 (2021) | |
| Section | Case Reports | |
| DOI | https://doi.org/10.18502/bccr.v13i4.14398 | |
| Keywords | ||
| Esophageal-pleural/bronchial fistula Esophageal cancer. | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Bhardwaj S, Kaushal V, Paul D. Enigma of Esophageal - Respiratory Fistula in Advanced Esophageal Cancer. Basic Clin Cancer Res. 2022;13(4):239-244.
