Stent Implantation For The Treatment Of Malignant Tracheoesophageal Fistula

Purpose We aim to explore the efficacy of stent implantation in the treatment of malignant tracheoesophageal fistula and evaluate the risk factors of survival after stent implantation.Materials and Methods Between January 2015 and December 2016,patients who un-derwent stent implantation for malignant tracheoesophageal fistula in Zhongda Hospital,Southeast University were retrospectively enrolled.The main outcomes were evaluated in term of technique success,fistula closure,KPS scores,infection control,complication and overall survival.Risk factors selected by univariate analysis for survival were identified by Cox’s proportional hazards regression model.Results 46 patients were included in this study,including 30 underwent esophageal stent implantation,6 underwent airway stent implantation and 10 underwent esophageal-airway double stents implantation.56 stents including 40 esophageal stent and 16 airway stent were successfully implanted,the technique success rate was 100%.45 of 46 fistulas(97.8%)were successfully closed.Postoperative KPS scores had been improved at 1 week(54.57±8.09),1month(68.04± 10.25),2 month(54.56± 14.49)and 3 month(52.57± 16.81)with preopera-tive KPS scores(39.78 ±7.15)(P<0.05).24 patient had pneumonias before operation and 19(79.2%)pneumonias were controlled after stent implantation.7 new pneumonias occurred af-ter stent implantation and 6 were controlled within 2 weeks.26 patients had uncontrolled long-term infections.Early complication:pain(9/46,19.5%),dyspnea(4.4%,2/46),hemor-rhage(2.2%,1/46).Late complication:fistula reopening(9/46,19.5%),stent blockage(17.3%,8/46),hemorrhage(8.7%,4/46),pain(3/46,6.5%).The mean survival time was 105 ±24 days.Univariate analysis for potential risk factors showed that past radiation therapy(P=0.003),fis-tula reopening(P=0.015),long-term infection control(P=0.008)were associated with survival time after stent implantation.Cox’s proportional hazards regression model showed that past radiation therapy(B=-0.800,P=0.021),long-term infection control(B=0.599,P=0.039)were independent risk factors of survival time after stent implantation.Conclusion Stent implantation is an effective palliative treatment for malignant trache-oesophageal fistula,especially in relieving the symbols and improving the quality of life.To patients who had previous radiation therapy history,efficacy of stent implantation is not good enough.Infection should be controlled strictly after stent implantation.