Which of the following statement(s) is/are true concerning tracheoesophageal fistulas?

a.The majority of acquired tracheoesophageal fistulas are due to malignant disease

c.Malignant tracheoesophageal fistulas represent one of the few indications for an endoesophageal prosthesis

Ninety percent of acquired fistulas between the esophagus and tracheobronchial tree in adults are the result of malignant disease. Tracheoesophageal fistulas complicate the course of disease in about 5% of patients who have esophageal carcinoma. Nearly 80% of patients with malignant tracheoesophageal fistulas die within three months of the onset of symptoms and in 85% of these patients, the cause of death is aspiration pneumonia, not distant metastatic disease. For the most part, malignant tracheoesophageal fistula represents incurable disease for which resection carries significant mortality and is seldom indicated. Palliative relief of recurrent aspiration is the aim of therapy. Effective occlusion of the fistula may be achieved by insertion of one of a variety of available endoesophageal endoprostheses. These tubes are placed into the esophagus with the aid of an esophagoscope and may occlude the esophageal side of the fistula sufficiently to allow swallowing of liquids without aspiration into the tracheobronchial tree. More recently, expandable metal stents have been used successfully in the treatment of malignant tracheoesophageal fistulas.

Nonmalignant fistulas result from the erosion by contiguous infected subcarinal mediastinal lymph nodes; trauma; late sequelae of chronic mid-esophageal traction diverticulum; or erosion by an endotracheal or tracheostomy tube cuff in a patient requiring prolonged ventilatory support. Small fistulas, such as resulting from an endotracheal intubation injury, are approached through a cervical collar or oblique incision anterior to the sternocleidomastoid muscle. Although such cuff injuries usually produce circumferential tracheal damage which necessitates a tracheal resection, this can also be performed through a cervical collar incision.