Prognostic factors after therapeutic bronchoscopy for tracheo- or bronchoesophageal fistulas: Results from the EpiGETIF registry

Abstract

IntroductionTreatment of malignant tracheo- or bronchoesophageal fistulas (TEF) using therapeutic bronchoscopy (TB) is not standardized and its outcomes are poorly described. This study aimed to analyze the characteristics of patients treated with TB for a TEF and to identify prognostic factors.MethodsWe analyzed data from 96 patients undergoing TB for TEF entered in the EpiGETIF registry between January 2019 and December 2022.ResultsThe mean age was 61.4 years. Median survival after TB was 2.40 months (95% CI 1.81–3.32). Histology was mainly represented by esophageal (72%) and lung (23%) cancers and did not influence prognosis (p=0.15), whereas smoking did (2.17versus3.32 months for non-smokers, p=0.04). Patients with poorperformance status(Eastern Cooperative Oncology Group >2) had shorter survival (1.99versus3.02 months, p=0.04). Sixty nine percent of patients had already received oncologic treatment, with no difference in survival (3.02versus2.21 months for treatment-naive patients, p=0.14). Neither the localization (trachea 61.5%, left main bronchus 34.4%, other 4.1%) nor the size of the fistulas (23% <5 mm, 20% 5–10 mm, 54% >10 mm) impacted survival (p=0.91 and p=0.83, respectively). An airway stent (AS) was placed in 92.7% of patients, mainly self-expanding metallic stents (45%). Patients treated with both an esophageal and AS had a better prognosis than patients treated with an AS alone (2.88versus1.77 months, respectively, p=0.02).ConclusionSurvival of patients treated with TB for a TEF is very poor, and is impacted by smoking, performance status, and the presence of an esophageal stent.