Management of airway involvement in patients with advanced esophageal cancer

Abstract

Introduction: Advanced esophageal cancer with airway invasion has a poor prognosis. Airway involvement includes stenosis from both extrinsic compression and direct tumor invasion or esophageal-respiratory fistula resulting in aspiration, mediastinis and pneumonia. Airway stenting has proven to be an effective palliation for these patients. Objectives: The primary endpoint was to evaluate airway involvement in advanced esophageal cancer patients and characterize those submitted to airway stenting. The second endpoint was to evaluate survival time after endoscopic therapy. Methods: Retrospective, descriptive analysis, based on medical records, of esophageal cancer patients submitted to bronchoscopy, in a 3-year period (Jan 2013–Dec 2015). Results: 31 patients were included, with an average age of 63 years and male predominance(87%). All patients had advanced esophageal cancer, 51,6% had esophageal stenting and 19,4% had percutaneous endoscopic gastrostomy. There was airway involvement in 77,4% patients, most frequently stenosis duo to invasion of the tracheobronchial wall (n=13;54,1%) or extrinsic airway compression (n=7;29,2%); 6 cases needed stenting. Six patients had esophageal-respiratory fistula (4 in trachea and 2 in left main stem); all were submitted to airway stenting. The mean survival time after intervention was 3,5 months (0,5 to 12months); 2 patients are still in follow up after 2 months. Conclusion: Bronchoscopy should be done in esophageal cancer patients for a correct staging and to identify, at an early stage, those needing endoscopic therapy. Endobronchial stenting is a palliative procedure that should be offered to patients with significant airway stenosis or esophageal-respiratory fistula.