Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Abstract

Background Thoracogastric airway fistula (TGAF) is a serious complication of esophagectomy for esophageal cancer. We conducted a systematic review of the appropriate therapeutic options for acquired TGAF. Methods We performed a literature search to identify relevant studies from PubMed, EMBASE, and Web of Science using the search terms “gastric airway fistula”, “gastrotracheal fistula”, “gastrobronchial fistula”, “tracheogastric fistula”, “bronchogastric fistula”, “esophageal cancer”, and “esophagectomy”. Result Twenty-four studies (89 patients) were selected for analysis. Cough was the main clinical presentation of TGAF. The main bronchus was the most common place for fistulas (53/89), and 29 fistulas occurred in the trachea. Almost 73% (65/89) of patients underwent non-surgical treatment of whom 87.7% (57/65) received initial fistula closure. Twenty-three patients underwent surgery, including 19 (82.6%) with initial closure. The 1-, 2-, 3-, 6-, and 9-month survival rates in patients who underwent surgical repair were 95.65%, 95.65%, 82.61%, 72.73%, and 38.10%, respectively, and the equivalent survival rates in patients with tracheal stent placement were 91.67%, 86.67%, 71.67%, 36.96%, and 13.33%, respectively. Conclusion TGAF should be suspected in patients with persistent cough, especially in a recumbent position or associated with food intake. Individualized treatment should be emphasized based on the general condition of each patient.

Management of Esophageal Cancer-Associated Respiratory–Digestive Tract Fistulas

“…All interventional techniques could prove significantly longer survival compared to best supportive care. A previous study aligns with this finding [ 15 ], while a meta-analysis of 89 S-RDF patients demonstrated longer survival after surgery compared to bronchial stenting [ 32 ].…”

“…Moreover, no previous study fully addressed anatomical considerations of RDF therapy: whether one or both fistula orifices should be sealed. This has been underlined by several studies, which concluded that the appropriate management of RDF is still uncertain and variable [ 18 , 32 , 34 ].…”

“…In well-selected patients, surgical intervention has resulted in significantly longer survival of 10–105.0 months [ 15 , 30 , 31 ]. For surgery-associated RDF (S-RDF), overall mortality has been reported to range between 25.0 and 57.1%, with inconsistent results regarding surgical (17.4–100.0%) and non-surgical (25.0–28.3%) outcome [ 18 , 32 , 33 ].…”

Airway management during left-sided gastrobronchial fistula repair after esophagectomy for esophageal carcinoma

“…GBF might develop either in the early or the late postoperative period after esophagectomy with gastric pull-up, and can occur anywhere in the respiratory tract, from the trachea to the lobar bronchus. The most common clinical signs and symptoms are cough on swallowing, followed by fever, choking, chest pain, dyspnea, pneumonia, and life-threatening hemoptysis; [ 10 ] respiratory failure with septic shock is the most common cause of death. [ 11 ] A thoracic computed tomography scan with contrast, gastroscopy, bronchoscopy, and upper gastrointestinal contrast studies typically confirm GBF presence.…”

Successful repair of a gastrobronchial fistula after esophagectomy: The sandwich technique with the endobronchial Watanabe spigot and the over-the-scope clip system

“…1 The treatment strategy for gastrobronchial fistula is still controversial; however, nonsurgical procedures are preferable because of the invasiveness of surgical procedures. 2 Previously, we performed surgery for similar cases; however, it required the removal of the gastric tube posterior to the sternum, which is extremely invasive. Here, the combination of EWS and the OTSC system was used as a nonsurgical procedure.…”