Three-step operation for esophago-left bronchial fistula with respiratory failure after esophagectomy: a case report with literature review

Abstract

Background The development of esophago-bronchial fistula after esophagectomy and reconstruction using a posterior mediastinal gastric tube remains a rare complication associated with a high rate of mortality. Case presentation A 63-year-old man with esophageal cancer underwent a thoracoscopic esophagectomy with two-field lymph node dissection and reconstruction via a gastric tube through the posterior mediastinal route. Postoperatively, the patient developed extensive pyothorax in the right lung due to port site bleeding and hematoma infection. Four months after surgery, he developed an esophago-left bronchial fistula due to ischemia of the cervical esophagus and severe reflux esophagitis at the site of the anastomosis. Because of respiratory failure due to the esophago-bronchial fistula and the history of extensive right pyothorax, right thoracotomy and left one-lung ventilation were thought to be impossible, so we decided to perform the surgery in three-step systematically. First, we inserted a decompression catheter and feeding tube into the gastric tube as a gastrostomy and expected neovascularization to develop from the wall of the gastric tube through the anastomosis after this procedure. Second, 14 months after esophagectomy, we constructed an esophagostomy after confirming blood flow in the distal side of the cervical esophagus via gastric tube using intraoperative indocyanine green-guided blood flow evaluation. In the final step, we closed the esophagostomy and performed a cervical esophago-jejunal anastomosis to restore esophageal continuity using a pedicle jejunum in a Roux-en-Y anastomosis via a subcutaneous route. Conclusion This three-step operation can be an effective procedure for patients with esophago-left bronchial fistula after esophagectomy, especially those with respiratory failure and difficulty in undergoing right thoracotomy with left one-lung ventilation.

Clinical Efficacy of Single-Port Thoracoscopic Lobectomy versus Three-Port Thoracoscopic Lobectomy for Lung Cancer

“…In recent years, with the development of minimally invasive medical technology, thoracoscopic surgery has been increasingly used in clinical practice. Video-assisted thoracoscopic lobectomy features significant advantages such as minimally invasive and mild pain, which can effectively shorten the hospital stay of patients [ 7 ] and reduce the incidence of postoperative complications. The National Comprehensive Cancer Network guidelines (NCCN) recommended thoracoscopic lobectomy as the standard surgical approach for the treatment of lung cancer in 2006 in light of its remarkable efficacy [ 8 ], and in the previous decade, different branches of the technique were developed from the previous four-port and three-port surgical approaches to the two-port and single-port ones.…”

A case of advanced hypopharyngeal cervical esophageal cancer with management of tracheoesophageal fistula and complete resection

“…Esophageal stents and airway-esophageal double stents are often selected for TEF, especially to close the stula and improve the quality of life. [11,12] Although there are reports of improved survival, [13,14] it is considered to be a palliative treatment, and associated disadvantages include the possibility of stula enlargement and di culty in surgical manipulation due to stenting. Surgical treatment may be an option, but most patients undergo esophageal bypass surgery [15,16] or muscle ap coverage [9,17] as a palliative treatment.…”

Postoperative thoracogastric necrosis associated with thoracogastric–tracheal fistula of an endoscopic McKeown-type resection of esophageal carcinoma

“…A pedicled subcutaneous fascia flap wrapping the trachea has been reported in the literature for TGTF, [2] but the mortality rate is higher, up to 64.3%. Sato [9] reported that the use of a 3-step surgery could be an effective procedure for TGTF. Above all, there have been no reports on the successful treatment of patients with TGN associated with TGTF during staged esophageal surgery.…”