[Esophago-respiratory fistulas of tumorous origin].

Esophago-respiratory fistulas developing in malignant disease have serious consequences by continuous airway contamination. Between 1984 and 1999 in the 1st Department of Surgery of Semmelweis University 1439 patients were treated with esophageal cancer. During regular examinations esophago-respiratory fistulas were detected in 163 patients (11.3% incidence). By analyzing data about these patients, we examined the causes, the characteristics of the disease and the possibilities and the efficiency of treatment. The mean age of these 163 patients was 55 (21-83) years, the ratio between men and women 3.7:1. By analyzing data of these patients according to their age, history, degree of dysphagia, weight loss, tumor size and survival rate, it can be noticed that there are two specific peaks, which differs from the average patients with esophageal tumors. Presumably, patients with esophago-respiratory fistulas can be divided into two groups. One consists of relatively younger patients with biologically more aggressive carcinomas, while the other group is of older patients where the fistula formation is the end stage of the slower progressing tumor. Twenty eight patients received irradiation before the fistula developed, most likely the longer survival rate contributed to the rise of the number of the fistulas. Ninety-five patients underwent endoscopic endoprosthesis implantation, 24 had the position of a stent corrected, 44 patients received palliative therapy, gastrostomy was performed in 15 patients. The median survival period was 5.0 months (0-46 months). Patients with endoprosthesis, gastrostomy and palliative treatment only had mean survival periods of 6.2 (1-46), 1.7 (0-5) and 1.6 (0-5) months. By sealing off the fistula, a successful endoscopic stent can end the serious airway contamination and the dysphagia, improving the quality of life and length of survival. Endoscopic endoprosthesis implantation is a feasible method in the treatment of patients with esophago-respiratory fistula.