Management of malignant bronchoesophageal fistulas

Twenty-four patients with a bronchoesophageal fistula due to a malignant lesion were seen during the eight years from 1974 to 1981. Twenty of the patients had carcinoma of the esophagus, and four patients had carcinoma of the lung. All three patients who had a Celestin tube inserted had gastric reflux, and in two, the fistula was not completely occluded. Four patients who had a cervical esophagostomy, feeding jejunostomy and ligation of the gastroesophageal junction died in the immediate postoperative period. The best palliative result was achieved in 17 patients who had a bypass of the fistula with the stomach. Fourteen had a substernal gastric bypass to the cervical portion of the esophagus, and three patients had a gastric bypass to the upper thoracic portion of the esophagus by way of a right thoracotomy. Although the operative deaths occurred in six of 17 patients, the surviving patients resumed oral feeding within ten to 14 days after operation, and the pneumonias cleared. These patients had, by far, the best palliative result. We, therefore, advocate substernal or intrathoracic bypass of the bronchoesophageal fistula as soon as the general condition of the patient permits.