Background & Aims: The development of an esophagorespiratory fistula (ERF) in patients with esophageal
cancer (EC) is associated with poor prognosis. We observed a high rate of vocal fold paralysis (VFP) in patients
with ERF. Data on prevalence and complications of VFP in ERF are lacking. The present study investigated the
incidence of VFP in patients with malignant ERF and examined possible risk factors and the impact on survival.
Methods: We performed a retrospective case-control study of 46 institutional cases of EC patients with ERF
in a time period of eleven years. Patients were matched to 92 randomly selected controls (EC patients without
ERF) in a 1:2 fashion for tumor localization and histology. Demographics, clinical characteristics, recurrence,
treatment modalities as well as survival were analyzed.
Results: Esophageal cancer patients with ERF developed more often VFP than EC patients without ERF (59%
vs. 21%; p=0.02; odds ratio (OR) 4.9). Esophageal cancer patients with ERF had a more pronounced weight
loss (7.1 vs. 11.5 kg; P = 0.008), as well as higher rates of esophageal (p=<0.001; OR 22.9) and tracheal stenting
(p=<0.001; OR 76.8). Proximal tumor growth (p=0.004; OR 7.9), fistula formation to the trachea (p=<0.001;
OR 17.2) and recurrent disease (p=0.04, OR 4.7) was associated with VFP development in EC patients with
ERF. Vocal fold paralysis in ERF did not adversely affect five-year survival.
Conclusions: Vocal fold paralysis is a common complication in more than half of the patients with ERF in
EC. It is associated with proximal tumor growth, fistula formation to the trachea and disease recurrence, but
does not influence survival.


aeroportia, gastric outlet obstruction, computed tomography scanning, radiological signs