Abstract Rationale Tracheoesophageal fistula (TEF) secondary to esophageal cancer carries a poor prognosis. This study aimed to assess the survival benefit of stent placement and identify subgroups most likely to benefit. Methods We conducted a single-center retrospective cohort study of 152 patients with esophageal cancer-related TEF treated between 2008 and 2022 at West China Hospital. After 1:1 propensity score matching (PSM), 110 patients (55 pairs) were included. The primary endpoint was overall survival (OS), with secondary outcomes including 30-day severe complications (respiratory failure and major bleeding). Survival was analyzed using Kaplan-Meier and Cox regression. Robustness was assessed with E-values, and subgroup analyses were performed. Results The stent group demonstrated significantly longer median OS than the non-stent group (426 vs. 59 days; HR = 0.65, 95% CI: 0.42-0.99, p = 0.047). Multivariable Cox analysis confirmed stent placement as an independent protective factor (HR = 0.57, 95% CI: 0.36-0.90, p = 0.015), with an E-value of 2.31. Subgroup analyses revealed enhanced benefit in patients with prior radiotherapy (HR = 0.18), chemotherapy (HR = 0.22), male patients (HR = 0.55), upper thoracic fistulas (HR = 0.24), larger esophageal fistulas (0.5 cm, HR = 0.50), and smaller airway fistulas (≤0.5 cm, HR = 0.51) (all p 0.05). The stent group also had a lower 30-day respiratory failure rate (9.1% vs. 29.1%, p = 0.0076). Conclusions Stent placement significantly improves survival in esophageal cancer-related TEF, especially in selected subgroups, supporting its role in individualized treatment strategies. This abstract is funded by: National Natural Science Foundation of China (82173182), Science and Technology Program of Sichuan (2023NSFSC1939) and Chengdu Science and Technology Project (2023-YF09-00039-SN)
Fang et al. (Fri,) studied this question.