Closure of esophagotracheal fistula after esophagectomy for esophageal cancer

Arimoto, Junji; Hatada, Atsutoshi; Kawago, Mitsumasa; Nishimura, Osamu; Maebeya, Shinji; Okamura, Yoshitaka

doi:10.1007/s11748-015-0537-8

Cited by 8 publications

(11 citation statements)

References 10 publications

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“…The range of treatments for RF include tube drainage [25] , clipping by endoscopy [26] , muscle flap [27][28][29][30] , and covered metallic stenting. In our study, a PMMC flap procedure was used to treat 3 out of the 8 patients with RF.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, a PMMC flap procedure was used to treat 3 out of the 8 patients with RF. There are reports of the use of muscle flaps, such as the sternocleidomastoid (SCM) flap [27] , intercostal (IC) flap [28] , PMMC flap [29] , and latissimus dorsi muscle (LDM) flap [30] in the treatment of the various types of fistula. The SCM muscle flap and IC flap are commonly used in the repair of esophageal fistulas and perforations.…”

Section: Discussionmentioning

confidence: 99%

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The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer

et al. 2016

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Background/Aims: Anastomotic leakage (AL) after esophagectomy is associated with high rates of postoperative morbidity and mortality. In cases with leakage, a refractory fistula (RF) is sometimes recognized after esophagectomy. The aim of this study was to evaluate the risk factors for RF after esophagectomy with gastric tube reconstruction. Methods: This study enrolled 244 consecutive esophageal cancer patients who had undergone esophagectomy with gastric tube reconstruction. RF was defined as a noncurative anastomotic site-cutaneous fistula that had been present for more than 2 months. We evaluated the risk factors for RF. Results: AL occurred in 30 patients (12.3%). There was one mortality case (0.4%) due to mediastinitis caused by AL in the present series. A multivariate analysis revealed that the subcutaneous route was an independent risk factor for AL (OR 4.42, 95% CI 1.42-13.8, p = 0.01), and that the subcutaneous route was an independent risk factor for RF (OR 13.30, 95% CI 2.50-71.30, p = 0.0024). Conclusion: The results of this retrospective study suggest that subcutaneous route was associated with an increased risk of RF after esophagectomy with gastric tube reconstruction. The preoperative identification of risk factors may contribute to the prevention of postoperative AL and RF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer

et al. 2016

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“…Of the 17 patients, 13 were alive at the time of reporting. Various tissue flaps were described, including three latissimus dorsi flaps, five pectoralis major flaps, two sternocleidomastoid muscle flaps, one intercostal muscle flap, one sternohyoid muscle flap, one skin perforator pedicled by an intercostal muscle flap, five pericardial flaps, and one pleural flap . No clear evidence supports the superiority of any one operative approach.…”

Section: Treatment Considerationsmentioning

confidence: 99%

Diagnosis, assessment, and management of surgical complications following esophagectomy

Grimminger

Goense

Gockel

et al. 2018

Annals of the New York Academy of Sciences

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“…A pedicled posterior pericardial flap or diaphragmatic flap is useful for a fistula located near the carina or near a peripheral bronchus [ 4 , 5 ]. A pectoralis major muscle flap or sternocleidomastoid muscle flap is useful for a fistula near or in the neck [ 6 , 7 ]. The intercostal muscle flap can usually reach the whole intrathoracic trachea and bronchus and is a highly versatile option [ 8 ].…”

Section: Case Presentationmentioning

confidence: 99%

Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer

et al. 2017

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BackgroundTracheoesophageal fistula (TEF) is a rare but life-threatening complication after esophagectomy. It has a high mortality rate and often leads to severe aspiration pneumonia. Various types of surgical repair procedures have been reported, but the optimal management of TEF is challenging and controversial. Treatment should be individualized to each patient.Case presentationA 66-year-old female underwent transthoracic esophagectomy with gastric tube reconstruction and an intrathoracic anastomosis for esophageal cancer. Three years later, she had hematemesis and was diagnosed with a gastro-aortic fistula due to a gastric ulcer. She underwent endovascular aortic repair urgently at another hospital. Two days later, she underwent total resection of the gastric tube, during which time an injury to the trachea occurred; it was repaired by patching the stump of the esophagus to the injury site. Two months later, descending aortic replacement was performed due to infection of the stent graft. Six months after the first operation, a TEF developed. The patient was referred to our hospital for further treatment. The fistula was ligated and divided via a cervical approach, and a pectoralis major muscle flap was used to cover the defect. Esophageal reconstruction with the pedunculated jejunum was performed via a subcutaneous route. The postoperative course was uneventful. The patient was discharged after 6 months of physical and dysphagia rehabilitation.ConclusionA TEF located near the cervicothoracic border was successfully treated with a pectoralis major muscle flap through a cervical approach. Total resection of a gastric conduit in the posterior mediastinum carries a risk of tracheobronchial injury; however, if such an injury occurs, surgeons should be able to repair the injury using a suitable flap depending on the injury site.

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Closure of esophagotracheal fistula after esophagectomy for esophageal cancer

Cited by 8 publications

References 10 publications

The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer

The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer

Diagnosis, assessment, and management of surgical complications following esophagectomy

Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer

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