RT Book, Section
A1 Magee, Mitchell J.
A1 Sonett, Joshua R.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Burt, Bryan M.
A2 Groth, Shawn S.
A2 Loor, Gabriel
A2 Wolf, Andrea S.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1170406795
T1 Management of Malignant Esophageal Fistula
T2 Sugarbaker’s Adult Chest Surgery, 3e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260026931
LK accesssurgery.mhmedical.com/content.aspx?aid=1170406795
RD 2024/04/19
AB Malignant  esophageal  fistula  occurs  infrequently,  yet  remains  one  of  the  most  challenging  complications  encountered  in  thoracic  oncology,  with  few  or  no  improvements  in  management  or  outcomes  in  the  past  decade.  It  may  occur  in  the  setting  of  complicated  esophageal  cancer,  presenting  at  an  advanced  stage  of  disease,  or  as  a  complication  of  treatment.  Occasionally,  perforation  and  fistula  may  complicate  the  initial  presenting  diagnostic  endoscopy.  The  fundamental  tenets  of  successful  management  of  any  fistula,  including  relief  of  distal  obstruction,  treatment  of  infection,  nutrition,  and  treatment  of  underlying  malignancy,  should  be  kept  in  mind  but  unfortunately  are  inherent  to  the  disease  process  and  usually  overwhelming  for  patient  and  clinician.  Increased  experience  with  covered  self-expanding  metal  stents  (SEMSs)  and  associated  delivery  systems  has  dramatically  changed  the  approach  to  managing  benign  esophageal  fistulas,  particularly  involving  the  tracheobronchial  tree.  Indeed,  nonoperative  management  of  perforations  and  fistulas  associated  with  benign  disease  of  the  esophagus  has  increasingly  proven  effective  and  may  include  a  combination  of  endoscopic  suture,  clips,  and  covered  stents  or  endoluminal  vacuum-assisted  therapies.  Unfortunately,  these  techniques  have  not  proven  appropriate  or  effective  in  managing  most  patients  with  perforations  complicated  by  malignant  disease.  Palliation  and  not  cure  is  the  objective  in  the  majority  of  patients  afflicted  with  this  uniformly  fatal  complication,  which  most  often  occurs  in  the  setting  of  advanced-stage  disease.  A  multidisciplinary  approach  to  accurate  and  precise  diagnosis  and  treatment  is  essential.