Efficacy And Prognostic Risk Factors Of Fully-Covered Nickel-Titanium Alloy Stent Placement In The Treatment Of Malignant Tracheoesophageal Fistula

Objective: Due to the low incidence of malignant tracheoesophageal fistula and the paucity of relevant clinical studies,the benefits of stent implantation have not been well documented.It remains unclear which factors may affect fistula closure.Therefore,the aim of this paper is to investigate the efficacy of stent placement for malignant tracheoesophageal fistula and the prognostic risk factors associated with the closure of the fistula.Methods: Between January 2015 and January 2021,344 patients who were diagnosed with malignant tracheoesophageal fistula in Zhongda Hospital,Southeast University were retrospectively enrolled.Demographics and clinical data were collected.Risk factors selected by univariate analysis for fistula closure were identified by multivariable logistic regression.Results: Data were collected from 344 patients with malignant tracheoesophageal fistula,finally,288 patients were analyzed in this study of which 94 cases were treated conservatively,170 cases were treated with a fully-covered Nickel-Titanium alloy esophageal stent and 24 were treated with a fully-covered Nickel-Titanium alloy tracheal stent.Among them,the delta Karnofsky’s performance status score values(after 2 weeks/before treatment [p=0.0028],after1 month/before treatment [p=0.0103])were significantly different between conservative and stent treatment.There was a significant reduction of pneumonia incidence in the stenting group(33.53%)than conservative treatment group(77.05%)after one month(p<0.0001).In addition,the closure of fistula were influenced by four independent risk factors: 1)treatment methods(p < 0.0001),2)fistula size(p=0.0003),3)preoperative white blood cell count(p=0.0042),and 4)preoperative Karnofsky’s performance status score(p=0.0001).Conclusion: A fully-covered Nickel-Titanium alloy stent implantation has become an effective method for malignant tracheoesophageal fistula compared to conservative treatment.Besides,a fully-covered Nickel-Titanium alloy stent implantation,smaller size of fistula,lower preoperative white blood cell count,and higher preoperative Karnofsky’s performance status score suggest a better outcome.