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Jefferson F. Ray, III
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Maruf A. Razzuk
Harold C. Urschel, Jr.
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Ann Thorac Surg 1978;25:516-520
© 1978 The Society of Thoracic Surgeons

Articles

Management of Malignant Esophagorespiratory Fistula

David M. Lolley, M.D.*, Jefferson F. Ray, III, M.D., Herbert T. Ransdell, M.D., Maruf A. Razzuk, M.D., Harold C. Urschel, Jr., M.D.

Departments of Cardiovascular and Thoracic Surgery, Marshfield Clinic, and St. Joseph's Hospital, Marshfield, WI, the University of Louisville Medical School and the Veterans Administration Hospital, Louisville, KY, and the University of Texas Southwestern Medical School, Dallas, TX

* Address reprint requests to Dr. Lolley, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449

Esophagorespiratory communication developed in 46 patients among 570 with esophageal cancer. Therapy was basically palliative and aimed at mechanical interruption of the fistula, restoration of esophageal continuity, and avoidance of external tubes and appliances. Supportive therapy, gastrostomy, tracheostomy, and esophageal exclusion and diversion procedures resulted in little prolongation of life and poor palliation of the patient. Permanent endoesophageal intubation with tubes of the Celestin variety resulted in best palliation with minimal operative risk for most terminal patients. Colon bypass and occasional resection can accomplish the same goal and possibly provide long-term survival in good-risk, young patients with small tumors.




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