114P - Risk factors for oesophageal fistula: A life-threatening complication of treatment for oesophageal cancer

Background

Oesophageal fistula is a life-threatening complication that may occur during oesophageal squamous cell carcinoma treatment. Clinical evidence of established risk factors for the development of fistula is limited. This study investigated the risk factors based on clinical data.

Methods

We retrospectively reviewed clinical data of patients with locally advanced (T4) oesophageal cancer who received chemoradiotherapy or chemotherapy alone in our institute between April 2018 and May 2022. Patients were excluded if they had a fistula before treatment started. T-test, Fisher’s exact test, and logistic regression analysis were used to analyse the data.

Results

Out of 42 patients studied, 19 developed fistula. All patients received chemotherapy. In the fistula group, 11 patients received definitive concurrent radiotherapy, one received palliative radiotherapy, and seven did not receive radiotherapy. Low body mass index (BMI) was the only significant risk factor associated with fistula formation (p=0.042). There was no significant association between oesophageal stricture at baseline, type of radiotherapies, ages, performance status, serum albumin, C-reactive protein, and neutrophil- lymphocyte ratio with fistula formation. The overall survival (OS) in the fistula group was significantly shorter than in the non-fistula group (275 days vs. 447 days, P=0.014). The median survival time from the development of the fistula was 58 days.

Conclusions

In this trial, low BMI at baseline independently increased the risk of oesophageal fistula occurring after oesophageal cancer treatment. It was also identified that oesophageal fistula is associated with poor prognosis. Further prospective studies are needed to establish other risk factors to avoid this unfavourable complication.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.