The clinical characteristics, treatments and prognosis of post-esophagectomy airway fistula: a multicenter cohort study

Bin, Zheng; Zeng, Taidui; Yang, Hong; Leng, Xuefeng; Yuan, Yong; Dai, Liang; Guo, Xufeng; Zheng, Yan; Chen, Maohui; Zheng, Kai; Zhang, Shuliang; Huang, Guanglei; Zheng, Wei; Harris, Kassem; Chen, Chun

doi:10.21037/tlcr-22-141

Cited by 6 publications

(3 citation statements)

References 27 publications

(34 reference statements)

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“…Approximately 75% of acquired ADFs are iatrogenic and develop following esophagectomy or other mediastinal surgery, pressure necrosis from a cuffed endotracheal tube, trauma from endoscopy, airway or esophageal stent erosion, and antineoplastic treatments including chemoradiation and bevacizumab ( 3 , 7 - 10 ). While antineoplastic treatments have been associated with the development of an ADF, its direct correlation may be overestimated since oncologic treatments can prolong survival and therefore allow more time for a fistula to develop and become symptomatic.…”

Section: Etiologiesmentioning

confidence: 99%

Management of aero-digestive fistulas in adults: the bronchoscopist’s perspective

Chang,

Lin

2023

Mediastinum

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Aero-digestive fistulas (ADFs) are pathologic connections between the airways and gastrointestinal system. These most commonly occur between the central airways and esophagus. Fistulas may develop congenitally or be acquired from a benign or malignant process. Most fistulas presenting in adulthood are acquired, with similar rates of benign and malignant etiologies. Symptoms may severely impact a patient’s quality of life and result in dyspnea, cough, and oral intolerance. ADFs have been associated with increased mortality, often related to pneumonias and malnutrition. Management is multifaceted and includes a multidisciplinary approach between the pulmonologist, gastroenterologist, and thoracic surgeon. While definitive management can be achieved with surgery, this is typically reserved for benign causes as surgical repair is often impractical in patients with advanced malignancies. With malignant causes, less invasive endoscopic and/or bronchoscopic interventions may be indicated. Stenting is the most common non-surgical invasive intervention performed. Stents can be placed in the esophagus, airway, or both. There is limited data that suggests outcomes may be better when esophageal stenting is performed with or without airway stenting. Airway stents are indicated when there is airway compromise, inadequate sealing of the fistula with an esophageal stent alone, or when an esophageal stent cannot be placed. This review will provide an overview of approaching ADFs from the bronchoscopist’s perspective.

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Section: Etiologiesmentioning

confidence: 99%

Management of aero-digestive fistulas in adults: the bronchoscopist’s perspective

Chang,

Lin

2023

Mediastinum

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“…In addition, post-esophagectomy airway fistula, a severe morbidity associated with the posterior mediastinal reconstruction approach, is a life-threatening condition that can result in respiratory failure and septic shock and typically occurs with an anastomotic leak [ 8 ]. Accumulated digestive content between the gastric conduit and the tracheobronchial tree can lead to the development of an airway fistula [ 9 ]. Therefore, reducing the accompanying distance between the gastric conduit and the airway (trachea and bronchi) may decrease the incidence of respiratory-digestive fistula.…”

Section: Introductionmentioning

confidence: 99%

A approach of gastric conduit via the anterior of pulmonary hilum route during minimally invasive McKeown esophagectomy

Yan,

Xu,

Guo

et al. 2024

J Cardiothorac Surg

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Background The gastric conduit is the most commonly used replacement organ for reconstruction after minimally invasive McKeown esophagectomy. Although the optimal route of gastric conduit remains controversial, the posterior mediastinal route is physiologically preferable but is not without disadvantages. Here, we report the safety and efficacy of a method of gastric conduit reconstruction via the anterior of the pulmonary hilum route. Methods We have used the anterior of the pulmonary hilum route since 2021. This procedure involves pulling the gastric conduit up through a substernal tunnel between the right thoracic cavity and the abdominal cavity and passing it into the neck via the anterior of the pulmonary hilum route. In this retrospective study, we compared the clinical outcomes between 20 patients who underwent this procedure and 20 patients who underwent the posterior mediastinal route from 2021 to 2022. Results No mortality was reported in either group. No significant differences were observed between the two groups in duration of surgery, blood loss, incidence of postoperative complications, and postoperative hospital stay. As a result of the anterior of the pulmonary hilum route, the primary tumor bed and lymph node drainage area were effectively bypassed, which facilitates postoperative adjuvant radiotherapy or chemoradiotherapy. The distance of the gastric conduit accompanying the airway was significantly shorter in the anterior of the pulmonary hilum route group. Conclusions Our method is considered to be a safe and useful technique for the reconstruction of gastric conduit.

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“… 2 , 3 Patients with ETBF generally require prolonged intensive care unit (ICU) stay, and mortality rates up to 60% have been reported. 4 …”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy

de Groot,

Kingma,

Goense

et al. 2023

Diseases of the Esophagus

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The aim of this study was to evaluate the surgical treatment of esophago-tracheobronchial fistulas (ETBFs) that occurred after esophagectomy with gastric conduit reconstruction in a tertiary referral center for esophageal surgery. All patients who underwent surgical repair for an ETBF after esophagectomy with gastric conduit reconstruction were included in a tertiary referral center. The primary outcome was successful recovery after surgical treatment for ETBF, defined as a patent airway at 90 days after the surgical fistula repair. Secondary outcomes were details on the clinical presentation, diagnostics, and postoperative course after fistula repair. Between 2007 and 2022, 14 patients who underwent surgical repair for an ETBF were included. Out of 14 patients, 9 had undergone esophagectomy with cervical anastomosis and 5 esophagectomy with intrathoracic anastomosis after which 13 patients had developed anastomotic leakage. Surgical treatment consisted of thoracotomy to cover the defect with a pericardial patch and intercostal flap in 11 patients, a patch without interposition of healthy tissue in 1 patient, and fistula repair via cervical incision with only a pectoral muscle flap in 2 patients. After surgical treatment, 12 patients recovered (86%). Mortality occurred in two patients (14%) due to multiple organ failure. This study evaluated the techniques and outcomes of surgical repair of ETBFs following esophagectomy with gastric conduit reconstruction in 14 patients. Treatment was successful in 12 patients (86%) and generally consisted of thoracotomy and coverage of the defect with a bovine pericardial patch followed by interposition with an intercostal muscle.

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The clinical characteristics, treatments and prognosis of post-esophagectomy airway fistula: a multicenter cohort study

Cited by 6 publications

References 27 publications

Management of aero-digestive fistulas in adults: the bronchoscopist’s perspective

Management of aero-digestive fistulas in adults: the bronchoscopist’s perspective

A approach of gastric conduit via the anterior of pulmonary hilum route during minimally invasive McKeown esophagectomy

Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy

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