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.
