Characteristics and Outcomes of Airway Involvement in Esophageal Cancer.

Abstract Background Airway involvement, such as airway invasion, compression, and tracheobronchoesophageal fistula (TOF), in esophageal cancer is associated with significant morbidity. However, the risk factors and outcomes of airway complications remain unclear, with limited evidence to guide management. Methods We conducted a retrospective analysis of 804 patients diagnosed with esophageal cancer from 1998 to 2018 at a tertiary-care medical center. Patient demographics, treatment details, airway involvement based on bronchoscopic evaluation and/or CT imaging were recorded and analysed to determine risk factors and outcomes of airway involvement. Results The incidence of airway involvement and TOF was 36.6% and 13.1% respectively. Airway involvement was associated with reduced survival from the time of diagnosis (HR 1.52 (95% CI 1.30–1.79) and increased hospitalizations per year (4.53±4.80 versus 2.75±3.68, p Conclusions Airway involvement and TOF is common and associated with increased morbidity and poorer survival. Clinicians should remain vigilant for airway complications after treatment with esophageal stenting, chemo- or radiotherapy, especially with mid and upper esophageal cancers. In patients who develop TOFs, improved survival is seen when they are treated with airway stenting, esophageal stenting, or chemotherapy.