Surgical Cervicothoracic-flap Repair of Neoesophagus-airway Fistula After Esophagectomy for Esophageal Cancer: A Retrospective Cohort Study

Overview

Journal JTCVS Tech

Date 2024 Feb 14

PMID 38351987

Authors

Thibaud Bertrand

Olaf Mercier

Nicolas Leymarie

Justin Issard

Jean-Francois Honart

Dominique Fabre

Frederic Kolb

Elie Fadel

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate outcomes of surgical repair of postesophagectomy neoesophagus-airway fistulas (NEAFs).

Methods: We retrospectively included consecutive patients with NEAF managed by various techniques at our center between August 2009 and July 2021.

Result: Of the 11 patients (median age, 60 years; interquartile range, 58, 62), 4 had received induction chemoradiotherapy and 4 others induction chemotherapy. NEAF was mainly a complication of anastomotic leakage (n = 6) or attempted stenosis treatment (n = 3). The airway mainly involved was the trachea (n = 8). Airway defects were repaired by resection-anastomosis (n = 5), perforator flaps (n = 4), pedicled pericardium (n = 1), and/or direct suturing (n = 2). Gastric conduit defects were repaired by perforator flaps (n = 6), direct suturing (n = 2), or pedicled pericardium (n = 1). Of the 7 perforator flaps, 4 were internal mammary-artery, two dorsal intercostal-artery, and one supraclavicular-artery flaps. After a median follow-up of 100 months, 2 patients died on early postoperative course from NEAF repair failure and 3 from late NEAF recurrence at 4, 11, and 33 months. Among the remaining 6 patients, 1 died from local tumoral recurrence at 13 months, 1 was last on follow-up at 27 months, alive and eating normally. The other 4 were free from NEAF recurrence and dysphagia or swallowing disorder at 50 months' follow-up. These 4 results were obtained thanks to perforator flap interposition and airway resection anastomosis.

Conclusions: Surgical NEAF repair using perforator flap interposition may provide satisfactory long-term function after strong prehabilitation.

Citing Articles

Surgical repair of benign thoracogastric airway fistula after esophagectomy using a pedicled myocutaneous flap.

Li C, Yang Y, Li B, Hua R, Sun Y, Li Z J Thorac Dis. 2024; 16(11):7926-7932.

PMID: 39678852 PMC: 11635255. DOI: 10.21037/jtd-24-1029.

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