How do you manage a patient who presents with a tracheoesophageal fistula from a lung or esophageal primary that is non-metastatic?
My experience with this has typically been with primary esophageal cancer presenting with TEF. It's obviously a challenging and individualized situation requiring multidisciplinary input and extensive clinical assessment and discussion. I generally recommend induction chemotherapy since the ideal sc...
In an excellent review article on this topic, (Shamji & Inculet, Thorac Surg Clin 2018, PMID: 30054077) the authors wrote “when a malignant fistula develops between esophagus and trachea, the underlying cancer is invariably incurable, whether the primary site is in the esophagus or in the trachea.” ...
Stabilization of the airway is important and should be established before starting treatment and reassessed throughout. For patients who clearly have a TE fistula prior to treatment, I agree with stenting. Even with stents, they may need a PEG to optimize nutrition because they still may not be safe...