Management of Tracheo‐ or Bronchoesophageal Fistula After Ivor‐Lewis Esophagectomy
- 25 February 2016
- journal article
- research article
- Published by Wiley in World Journal of Surgery
- Vol. 40 (7), 1680-1687
- https://doi.org/10.1007/s00268-016-3470-9
Abstract
Background The development of tracheo- or bronchoesophageal fistula (TBF) after Ivor-Lewis esophagectomy remains to be a rare complication associated with a high mortality rate. Methods In this retrospective study, the charts of patients with TBF after esophagectomy were analyzed in terms of individual patient characteristics, esophagotracheal complications, respiratory function, management, and outcome. Results Between January 2000 and December 2014, 1204 patients underwent Ivor-Lewis esophagectomy for esophageal cancer; 13 patients (1.1 %) developed a TBF. In all 13 patients, a concomitant leakage of the intrathoracic esophagogastrostomy was evident, either prior to diagnosis of TBF (metachronous TBF) or simultaneously (synchronous TBF). TBF was predominantly located in the left main bronchus (n = 6, 46.1 %) or trachea (n = 5, 38.5 %). Management of TBF included re-thoracotomy (n = 7), interventional endoscopic (n = 10) or bronchoscopic therapy (n = 4). In the majority of patients (n = 8), management consisted of two subsequent treatment modalities. In 3 out of four patients, TBF was successfully treated by endoscopic stenting only. Five patients (38.5 %) died following a septic course with multiple organ failure. Conclusions The development of TBF after Ivor-Lewis esophagectomy is always combined with anastomotic leakage of the esophagogastrostomy. Treatment options primarily depend on the vascularization of the gastric conduit, the severity of the concomitant aspiration pneumonia, and the volume of the air leakage.This publication has 22 references indexed in Scilit:
- Preoperative Chemoradiotherapy for Esophageal or Junctional CancerThe New England Journal of Medicine, 2012
- Surgical Management of Acquired Nonmalignant Tracheoesophageal and Bronchoesophageal FistulaeThe Annals of Thoracic Surgery, 2010
- Worldwide esophageal cancer collaborationDiseases of the Esophagus, 2009
- Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stentSurgical Endoscopy, 2009
- Laparoscopic Ischemic Conditioning of the Stomach for Esophageal ReplacementAnnals of Surgery, 2007
- Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal CancerThe New England Journal of Medicine, 2006
- Mortality and Morbidity after Resection for Adenocarcinoma of the Gastroesophageal Junction: Predictive FactorsJournal of the American College of Surgeons, 2005
- Classification of Surgical ComplicationsAnnals of Surgery, 2004
- Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort studyBMJ, 2003
- Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcomeBritish Journal of Surgery, 1998