Introduction 

Bronchoscopic treatment of malignant tracheo-or broncho-oesophageal fistula (TOF) is not well standardized and its outcomes poorly known. This study aimed to describe the population of patients undergoing therapeutic bronchoscopy (TB) for a TOF and to identify prognostic factors.

Methods

We analyzed data prospectively collected in the French EpiGETIF registry from all patients undergoing TB for a TOF, with or without airway stenting (AS).

Results

96 patients were treated from January 2019 to December 2022. Mean age was 61.4 (±9.5 SD)years old. Median survival after TB was 2.4 months. Histology distribution was dominated by oesophageal (72%) and lung (23%) cancers and did not influence prognosis (p=0.15), while tobacco did (2.2 vs 3.3 months for non-smokers, p=0.04). Patients with an altered performance status (PS>2) had a lower survival compared to others (1.9 vs 3.0 months, p=0.04). 68.8% of patients were pretreated, with no significant difference in survival (3.0 vs 2.2 months for treatment-naïve patients, p=0.14). Fistulas were mostly into the trachea (61.5%) or the left main bronchus (34.4%). 23% of TOF were < 5 mm, 20% 5-10 mm and 54% > 10 mm, without impact on survival (p=0.83). AS was performed in 92.7% of patients, mostly covered self-expandable metallic stents (45%) and silicone stents (44%). Patients who underwent both oesophageal and AS had a better survival compared to patients treated only with AS (2.8 and 1.7 months, respectively, p=0.03).

Conclusion

Bronchoscopic treatment of TOF is associated with a poor survival that is related with tobacco use, PS and the absence  of an oesophageal stent, but not with histology, previous treatments or the size of the fistula.