Ribeiro MSI, et al. - Risk factors associated with clinical failure after self-expandable metal stent (SEMS) placement for the treatment of malignant esophagorespiratory fistula (MERF) were identified. For MERF, SEMS placement was a reasonable treatment option. However, Eastern Cooperative Oncology Group (ECOG) 3 or 4 and fistula development during esophageal cancer treatment could be independent predictors of clinical failure after stent placement.

• The clinicians performed this retrospective analysis of a prospectively maintained database used at a tertiary cancer hospital, with patients treated with SEMS placement for MERF between January 2009 and February 2016.
• They used logistic regression to identify predictive factors for clinical outcomes, and to estimate the odds ratio (OR) and the 95% confidence interval (CI).
• They used Kaplan-Meier method for survival analysis.
• Using the log-rank test, comparisons were made.

• The clinicians included 71 patients (55 males, mean age 59 years) in the study.
• Out of them, 70 were considered for the final analysis (one failed stent insertion).
• They noted clinical failure in 44% of the patients.
• During esophageal cancer treatment, ECOG 3 or 4 and fistula development were associated with increased risk of clinical failure.
• Predictive factors associated with lower overall survival were ECOG 3 or 4, pulmonary infection at the time of SEMS placement and prior radiation therapy.
• 15 days after stent insertion, dysphagia scores improved significantly.
• 30% was the overall stent-related adverse events rate.
• The most commonly seen adverse events were stent migration and occlusion because of tumor overgrowth.