Treatment Experience of Esophageal Fistula Induced by Neoadjuvant Therapy in Esophageal Squamous Cell Carcinoma: A Single-Center Experience

Background Esophageal squamous cell carcinoma (ESCC) is typically treated with neoadjuvant therapy followed by esophagectomy. However, some patients develop esophageal fistulas during neoadjuvant treatment due to an imbalance between tumor regression and tissue healing. The emergence of esophageal fistulas presents significant challenges for subsequent management and has generated considerable debate regarding the best treatment approaches. This study retrospectively evaluates the outcomes of patients who developed esophageal fistulas during neoadjuvant therapy at our center. Methods We included patients with locally advanced ESCC who received neoadjuvant treatments, which consisted of chemoradiotherapy, chemotherapy, or chemoimmunotherapy. The types of esophageal fistulas identified included esophageal-mediastinal(EMF), esophageal-aortic(EAF), esophageal-pulmonary(EPF), esophageal-pericardial(EPCF), and esophageal-tracheal fistulas(ETF). We analyzed the subsequent treatment strategies and clinical outcomes for these patients. A total of 12 patients were included in the study until September 30, 2024. The distribution of esophageal fistulas was as follows: EMF (3 patients), EAF (1 patient), EPF (3 patients), EPCF (1 patient), and ETF (4 patients). Results Of the 3 patients with EMFs, 2 underwent mediastinal abscess drainage combined with radical esophagectomy, while the patient with EAF died from hemorrhage. All patients with EPFs underwent combined esophagectomy and lobectomy. The remaining patients received interventional therapy without surgical intervention. Among the 6 patients who underwent surgery, 2 developed pyothorax, both of whom recovered after appropriate drainage. With a median follow-up of 15.3 months, two patients who underwent surgery experienced local recurrence, and one patient developed distant metastasis. The median survival times for patients who underwent surgery and those who did not were 12.2 months and 6.7 months, respectively. Conclusion Active surgical intervention is essential in the management of patients with esophageal fistulas following neoadjuvant therapy for ESCC. Surgical teams must remain vigilant regarding the potential for infectious complications in these patients.