Risk factors for the development of esophagorespiratory fistula in esophageal cancer

Abstract

Background & Aims: The development of esophagorespiratory fistula (ERF) in esophageal cancer (EC) is a devastating complication, leading to poor survival rates and low quality of life. The aim of this study was to identify the risk factors leading to fistula formation in EC. Methods: We identified 47 patients with malignant ERF formation in EC in a period of 10 years. Clinical characteristics were compared by univariable analysis with 47 randomly selected patients with EC without ERF. A case-control study was conducted for patients with squamous cell carcinoma (SCC) and ERF matching in a 1:2 fashion for primary tumor location. Results: The identified risk factors in EC patients were histology of SCC (p < 0.001), former or current smoking status (p = 0.002) and primary tumor location in the proximal esophagus (p < 0.001). The „hot spot” for ERF formation was tumor growth 20-25 cm distal to dental arch. An additional risk factor in SCC patients was age. Patients with ERF formation in SCC were younger than patients without ERF (median 63 vs. 67 years, p = 0.02). No difference in the rate of fistula formation was seen between esophagectomy and definitive chemoradiation, but the latter developed ERF earlier in the course of the disease (237 vs. 596.5 days, p = 0.01). Conclusion: Patients with proximal SCC of the esophagus and a smoking history, as well as young patients with SCC should be closely monitored for ERF formation.