Efficacy of airway stenting and nasogastric tube insertion in airway-esophageal fistula patients with airways compromised by advanced malignancy.

INTRODUCTION: Whether airway-compromised airway-esophageal fistula (AEF) patients should undergo combined airway and esophageal stenting is controversial. This study was designed to evaluate the survival prognosis and poststent interventions in AEF patients with airways compromised by advanced malignancy with or without airway stents. METHODS: A retrospective analysis of the medical records, survival times, and poststent interventions of 17 patients with or without airway stents was performed. RESULTS: The causes of AEF were esophageal cancer (11/17, 64.7%), lung cancer (6/17, 29.4%), and thyroid cancer (1/17, 5.9%). All patients received a nasogastric tube (n = 12) or underwent gastrostomy (n = 5) to resume enteral nutrition. Thirteen patients underwent airway stent insertion (13/17, 76.5%), whereas four patients did not. Four patients with a high risk of stent migration received external stent fixation to the trachea. Three of the patients with stents suffered severe granulation tissue formation and needed repeated bronchoscopy interventions. In the stented group, none of the patients developed stent migration, and the overall median survival time was 9 months, compared with 1.25 months in the nonstented group (P = 0.04). Cox proportional hazards regression revealed that stent insertion, nasogastric tube insertion, and transcatheter bronchial artery chemoembolization were protective factors against death, whereas surgery-related fistula, fistula larger than 2 cm, continued chemotherapy, and age were risk factors for poor survival (P < 0.05). CONCLUSION: In airway-compromised AEF patients, airway stents and nasogastric tubes are probably the preferred treatments. Airway stenting is tolerable, and routine weekly poststent bronchoscopy is needed in the first month and depending on respiratory symptoms thereafter.

Survival outcomes of radiofrequency ablation compared with surgery in patients with early-stage primary non-small-cell lung cancer: A meta-analysis.

BACKGROUND: This study compared the overall survival (OS) of patients with early-stage primary non-small-cell lung cancer (NSCLC) treated with radiofrequency ablation (RFA) versus surgery. METHODS: A systematic search was performed in MEDLINE, Embase, Cochrane Central Register, and all available Chinese databases to identify relevant publications from inception to April 2019. This meta-analysis compared hazard ratios (HRs) for OS. A multivariate fixed effects model was used to perform a meta-analysis to compare survival between treatments. RESULTS: Six retrospective studies were included in the quantitative synthesis. Compared with surgery, RFA was associated with a similar long-term OS. The HRs and 95% confidence intervals (CIs) for 2-, 3- and 5-year OS were 1.74 [0.82, 3.71], 1.15 [0.65, 2.02] and 2.69 [0.41, 17.47], respectively, while those of the pooled data were 1.47 [0.94, 2.32] in patients with early-stage primary NSCLC. CONCLUSIONS: RFA did not differ significantly from surgery in terms of the 5-year OS in patients with early-stage primary NSCLC. Randomized, controlled clinical trials are warranted to compare these two treatments.