Malignant tracheoesophageal fistula

Malignant tracheoesophageal fistula occurs infrequently in patients with esophageal and lung cancer. However, the occurrence of this entity is very distressing for the patient since it leads to rapid deterioration and death due to overwhelming pulmonary infection. A review of cases reported in the recent world literature is presented. The only effective treatment is to exclude the fistula from the alimentary tract. This may be achieved by intubation or operation. Intubation is probably associated with a lower mortality but is less certain to control the fistula. Single-stage operative exclusion and bypass is preferred under ideal circumstances. However, the patient's condition may dictate that a two-stage operation be performed--first, operative exclusion of the fistula and then, if the patient's respiratory and nutritional state improves sufficiently, restoration of alimentary continuity at a later date.