Surgical treatment of a serious complication: oesophago-pulmonary and cervical oesophago-tracheal fistula after radiochemotherapy and immunotherapy

Background Oesophago-respiratory fistulas are a rare complication of pulmonary malignancy or its treatment. Aspiration pneumonia and the advanced tumour stage usually do not allow surgical treatment. Therefore, this complication is associated with high morbidity as well as mortality.

Methods & Materials We present the case of a patient with non-small cell lung carcinoma of the right upper lobe and infiltration of the mediastinum. After definitive combined radiochemotherapy, an oesophago-pulmonary fistula developed to the right upper lobe. After stent implantation into the oesophagus, a cervical oesophago-tracheal fistula developed at the upper edge of the oesophageal stent.

Results Under vv-ECMO, a combined oesophageal and pulmonary resection with gastric elevation and cervical anastomosis as well as a cervical tracheostomy were performed. Except for a secondary wound healing at the posterior tracheal wall, the postoperative course was without complications. Histopathological examination of the surgical specimens showed complete remission. The patient was discharged on foot from inpatient treatment.

Conclusion The successful outcome of a case like this can be attributed to the comparatively good general condition of the patient, the effective modern oncological therapy, thorough preoperative diagnostics as well as careful planning and implementation of this complex intervention. In principle, surgical repair should at least be considered in patients with complicated oesophago-respiratory fistulas in the context of malignant disease. In this way, even supposedly palliative therapy prospects can be converted into curative regimens.

Publication History

Article published online:
25 August 2025