Combined Airway and Esophageal Stenting in Malignant Airway-Esophageal Fistulas: A Prospective Study

Background: Malignant airway-esophageal fistulas are a serious complication of advance esophageal or lung cancers. Aims: To assess the quality of life pre and post stent insertion and to examine the role of treatment and location of AEF as factors influencing survival in patients with AEF managed with airway and/or esophageal stent insertion Methods: 112 patients with airway–esophageal fistula were prospectively included. 83 patients (74%) had advanced lung cancer and 29 patients (26%) esophageal cancers. Results: Airway stents were inserted in 65 patients (58%), esophageal in 37 (33%) patients and both airway and esophageal stents in 10 (9%) patients. 7 patients (6 %) developed respiratory failure and required transient ventilator support in the intensive care unit (4 patients with airway stenting, 2 patients with double and 1 in the esophageal stenting group). None of the patients developed stent migration or needed stent repositioning. Overall, mean survival was 236.6 days (airway stent 219.1 days, esophageal stent 262.8 days and combined airway-esophageal stent 252.9 days). Backward stepwise regression revealed the site of stent placement (airway and/or esophagus) (p < 0.028), exact location of fistula in airway (p= 0.011) and additional treatment with chemotherapy and/or radiation (p < 0.001) as independent risk factors predicting increased survival. The mean quality of life score (EQL-30 (QOL) was 81 prior to stent insertion and 72 post stent insertion (p < 0.001). Conclusion: To conclude, airway and/or esophageal stent insertion provides an effective approach to improve the quality of life in patients with malignant AEF.