Standardized Management of Esophageal Fistula in Esophageal Squamous Cell Carcinoma

Inclusion Criteria: * Voluntary participation and provision of written informed consent. * Age between 18 and 75 years (inclusive). * Histologically confirmed diagnosis of esophageal squamous cell carcinoma. * Radiologically confirmed unresectable, advanced disease. * Newly diagnosed esophageal fistula (including tracheoesophageal fistula or mediastinal esophageal fistula). * Previous receipt of ≤ 3 lines of systemic anti-tumor therapy. * Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2. * Adequate organ and marrow function within 7 days prior to potential anti-tumor treatment, as defined by: * Hemoglobin ≥ 9.0 g/dL * Absolute neutrophil count (ANC) ≥ 1.5 × 10⁹/L * Platelet count ≥ 100 × 10⁹/L * Total bilirubin (TBIL) ≤ 1.5 × the upper limit of normal (ULN) * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × ULN (or ≤ 5 × ULN in the presence of liver metastases) * Serum creatinine ≤ 1.5 × ULN * Adequate cardiac, pulmonary, and renal function to be eligible for general anesthesia, with no contraindications to general anesthesia. Exclusion Criteria: * Patients with postoperative anastomotic fistula. * Uncontrolled active bleeding. * Presence of a concurrent primary malignancy other than esophageal carcinoma. * Clinically significant cardiovascular disease, including but not limited to: * Heart failure (NYHA Class III-IV) * Uncontrolled coronary artery disease, cardiomyopathy, or arrhythmia * Uncontrolled hypertension * History …