1
|
Takeuchi H, Yoshimura S, Daimon M, Sakina Y, Seki Y, Ishikawa S, Kouno Y, Tashiro J, Kawasaki S, Mori K. Late-onset lethal complication of non-surgically managed massive gastric conduit necrosis after esophagectomy: a case report. Surg Case Rep 2024; 10:148. [PMID: 38884681 PMCID: PMC11182997 DOI: 10.1186/s40792-024-01955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Gastric conduit necrosis (GCN) after esophagectomy is a serious complication that can prove fatal. Herein, we report a rare case of GCN with a severe course that improved with conservative treatment. CASE PRESENTATION We present the case of a 78-year-old male patient who underwent an Ivor Lewis esophagectomy and developed a massive GCN. The patient was critically ill in the initial phase but recovered quickly; he also had a ruptured gallbladder and a bleeding jejunal ulcer. On the 22nd postoperative day, massive GCN was revealed on endoscopy. Considering the recovery course, careful observation with a decompressing nasal gastric tube was the treatment of choice. The GCN was managed successfully, having been completely replaced by fine mucosa within 9 months postoperatively. The patient completed his follow-up visit 5 years after surgery without any evident disease recurrence. Five and a half years after the surgery, the patient presented with progressive weakness and deterioration of renal function. Gastrointestinal endoscopy revealed a large ulcer at the anastomotic site. Three months later, computed tomography revealed a markedly thin esophageal wall, accompanied by adjacent lung consolidation. An esophagopulmonary fistula was diagnosed; surgery was not considered, owing to the patient's age and markedly deteriorating performance status. He died 2013 days after the diagnosis. CONCLUSIONS Massive GCN after esophagectomy often requires emergency surgery to remove the necrotic conduit. However, this report suggests that a conservative approach can save lives and preserve the gastric conduit in these cases, thereby augmenting the quality of life.
Collapse
Affiliation(s)
- Hiroshi Takeuchi
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Shuntaro Yoshimura
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Mitsuhiro Daimon
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Yasunobu Sakina
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Yusuke Seki
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Shintaro Ishikawa
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Yoshiharu Kouno
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Jo Tashiro
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Seiji Kawasaki
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Kazuhiko Mori
- Department of Digestive Surgery, Mitsui Memorial Hospital, 1 Kanda Izumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan.
| |
Collapse
|
2
|
Mammana M, Verzeletti V, Dell'Amore A, Rea F. An alternative surgical access for posterior tracheal defects or fistulae situated between the cervical and thoracic region. Updates Surg 2024; 76:653-656. [PMID: 37943495 DOI: 10.1007/s13304-023-01682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
Posterior tracheal lesion defects between the cervical and the thoracic region represent a surgical challenge. Cervicotomy or median sternotomy might not allow a satisfactory exposure of the defect, and a history of prior neck surgeries could further complicate the procedure. We propose a high posterior right thoracotomic approach, by which the entire posterior aspect of the trachea is visible, up to the cervical region. We describe our experience with this approach, which is best suited for cases where a non-circumferential repair of the trachea is attempted.
Collapse
Affiliation(s)
- Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Vincenzo Verzeletti
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Via Giustiniani, 2, 35128, Padua, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Via Giustiniani, 2, 35128, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Via Giustiniani, 2, 35128, Padua, Italy
| |
Collapse
|
3
|
Zhang C, Li X, He Z, Wang S, Yin M, Ma Y, Wu G. The Two-Tube Method for Treating Thoracogastric Airway Fistula. Thorac Cardiovasc Surg 2024; 72:156-161. [PMID: 37402403 DOI: 10.1055/a-2122-7149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Thoracogastric airway fistula (TGAF) is a fatal complication after esophagectomy. Without active treatment, patients may die of intractable pneumonia, sepsis, massive hemoptysis, or respiratory failure. We determined the clinical value of the two-tube method that involves the precise interventional placement of the nasojejunal tube (NJT) and nasogastric tube (NGT) for TGAF. METHODS Clinical data of patients with TGAF who had undergone fluoroscopic interventional placement of NJT and NGT were analyzed retrospectively. The paired t-test was used to compare the index values before and after treatment. Statistical significance was set at p < 0.05. RESULTS In total, 212 patients (177 male and 35 female; mean age, 61.3 ± 7.9 years [47-73]) with TGAF who had undergone the two-tube method were included. Posttreatment chest spiral computed tomography and inflammatory indicators showed significantly improved pulmonary inflammation compared with that before treatment. The patients' general condition remained stable. Of 212 patients, 12 (5.7%) underwent surgical repair, 108 (50.9%) received placement of airway stents, and 92 (43.4%) cases only continued treatment with the two-tube method owing to patients' conditions. In total, 47.8% (44/92) patients died of secondary pulmonary infection, bleeding, and primary tumor progression, whereas 52.2% (48/92) patients survived with both tubes. CONCLUSION The two-tube method, which involves the precise interventional placement of the NJT and NGT, is simple, safe, and effective for treating TGAF. This method is a bridge for successive treatments or a treatment itself for patients who are unsuitable for surgical repair or stent placement.
Collapse
Affiliation(s)
- Chenchen Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Xiaobing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhanfeng He
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Shuai Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yaozhen Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| |
Collapse
|
4
|
Bertrand T, Mercier O, Leymarie N, Issard J, Honart JF, Fabre D, Kolb F, Fadel E. Surgical cervicothoracic-flap repair of neoesophagus-airway fistula after esophagectomy for esophageal cancer: A retrospective cohort study. JTCVS Tech 2024; 23:123-131. [PMID: 38351987 PMCID: PMC10859646 DOI: 10.1016/j.xjtc.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 02/16/2024] Open
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.
Collapse
Affiliation(s)
- Thibaud Bertrand
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Olaf Mercier
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Nicolas Leymarie
- Department of Reconstructive Surgery, Gustave Roussy, Villejuif, France
| | - Justin Issard
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | | | - Dominique Fabre
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Frédéric Kolb
- Department of Reconstructive Surgery, University of California, San Diego, San Diego, Calif
| | - Elie Fadel
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| |
Collapse
|
5
|
de Groot EM, Kingma BF, Goense L, van der Kaaij NP, Meijer RCA, Ramjankhan FZ, Schellekens PAA, Braithwaite SA, Marsman M, van der Heijden JJ, Ruurda JP, van Hillegersberg R. Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy. Dis Esophagus 2024; 37:doad054. [PMID: 37592909 PMCID: PMC10762505 DOI: 10.1093/dote/doad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 08/19/2023]
Abstract
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.
Collapse
Affiliation(s)
- E M de Groot
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B F Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R C A Meijer
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A A Schellekens
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S A Braithwaite
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Marsman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J van der Heijden
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
6
|
Włodarczyk J, Smęder T, Obarski P, Ziętkiewicz M. Treatment of Esophago-Airway Fistula after Esophageal Resection. Healthcare (Basel) 2023; 11:3165. [PMID: 38132055 PMCID: PMC10743300 DOI: 10.3390/healthcare11243165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: Esophago-airway fistula after esophageal resection is a rare, life-threatening complication associated with a high postoperative mortality rate. Managing this condition is challenging, and the prognosis for patients is uncertain. The results and our own approach to treatment are presented. (2) Material and Methods: We present a retrospective analysis of a group of 22 patients treated for an esophago-airway fistula between 2012 and 2022, with 21 cases after esophageal resection and one during the course of Hodgkin's disease. (3) Results: Twenty-two patients were treated for an esophago-airway fistula. Among them, a tracheobronchial fistula occurred in 21 (95.4%) patients during the postoperative period, while 1 (4.5%) was treated for Hodgkin's disease. Of these cases, 17 (70.7%) patients underwent esophageal diversion with various treatments, including intercostal flap in most cases, greater omentum in one (4.5%), latissimus dorsi muscle in two (9%), and greater pectoral muscle in one (4.5%). Esophageal stenting was performed in two patients (9.0%), and one (4.5%) was treated conservatively. Unfortunately, one patient (4.5%) died after being treated with bronchial stenting, and two (9.5%) experienced a recurrence of the fistula. (4) Conclusions: The occurrence of an esophago-airway fistula after esophagectomy is a rare but life-threatening complication with an uncertain prognosis that results in several serious perioperative sequelae.
Collapse
Affiliation(s)
- Janusz Włodarczyk
- Department of Thoracic and Surgical Oncology, Jagiellonian University Collegium Medicum, John Paul II Hospital, 31-202 Cracow, Poland
| | - Tomasz Smęder
- Department of Thoracic and Surgical Oncology, John Paul II Hospital, 31-202 Cracow, Poland; (T.S.); (P.O.)
| | - Piotr Obarski
- Department of Thoracic and Surgical Oncology, John Paul II Hospital, 31-202 Cracow, Poland; (T.S.); (P.O.)
| | - Mirosław Ziętkiewicz
- Department of Anesthesiology and Intensive Care, Jagiellonian University Collegium Medicum, John Paul II Hospital, 31-202 Cracow, Poland;
| |
Collapse
|
7
|
Mao Y, Gao S, Li Y, Chen C, Hao A, Wang Q, Tan L, Ma J, Xiao G, Fu X, Fang W, Li Z, Han Y, Chen K, Zhang R, Li X, Rong T, Fu J, Liu Y, Mao W, Xu M, Liu S, Yu Z, Zhang Z, Fang Y, Fu D, Wei X, Yuan L, Muhammad S, He J. Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): a multicenter prospective cohort study. JOURNAL OF THE NATIONAL CANCER CENTER 2023; 3:106-114. [PMID: 39035730 PMCID: PMC11256603 DOI: 10.1016/j.jncc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Background Whether minimally invasive esophagectomy (MIE) is superior to open esophagectomy (OE) in the treatment of esophageal squamous cell carcinoma (ESCC) is still uncertain. Therefore, this multicenter prospective study aimed to compare MIE with OE in postoperative parameters and long-term survival. Methods All hospitalized patients with cT1b-3N0-1M0 thoracic ESCC treated by MIE or OE were enrolled from 19 selected centers from April 1, 2015 to December 31, 2018. The propensity score matching (PSM) was performed to minimize the selection bias. The basic clinicopathological characteristics and 3-year overall survival (OS) as well as disease-free survival (DFS) of two groups were compared by R version 3.6.2. Results MIE were performed in 1,387 patients and OE in 335 patients. 335 cases in each group were finally matched by PSM, and no significant differences in the essential demographic characteristics were observed between the MIE and OE groups after PSM. Compared with OE, MIE had significantly less intraoperative bleeding, less total drainage volume, shorter postoperative hospital stay, and harvested significantly more lymph nodes (LNs) (all P < 0.001). There were no significant differences in the major postoperative complications and death rates between MIE and OE. The 3-year OS and DFS were 77.0% and 68.1% in the MIE group versus 69.3% and 60.9% in the OE group (OS: P = 0.03; DFS: P = 0.09), and the rates were 75.1% and 66.5% in the MIE group versus 66.9% and 58.6% in the OE group for stage cII patients (OS: P = 0.04, DFS: P = 0.09), respectively. Conclusions Compared with OE, MIE is a safe and effective treatment approach with similar mortality and morbidity. It has the advantages in harvesting more LNs, improving postoperative recovery and survival of stage cII ESCC patients.
Collapse
Affiliation(s)
- Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Hospital, Fuzhou, China
| | - Anlin Hao
- Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshang Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshang Hospital, Fudan University, Shanghai, China
| | - Jianqun Ma
- Department of Thoracic Surgery, Heilongjiang Cancer Hospital, Harbin, China
| | - Gaoming Xiao
- Department of Thoracic Surgery, Hunan Cancer Hospital, Changsha, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji University, Wuhan, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Keneng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing University, Beijing, China
| | - Renquan Zhang
- Department of Thoracic Surgery, First Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Xiaofei Li
- Department of Thoracic Surgery, The Fourth Military University Hospital, Xian, China
| | - Tiehua Rong
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Meiqing Xu
- Department of Thoracic Surgery, Anhui Provincial Hospital, Hefei, China
| | - Shuoyan Liu
- Department of Thoracic Surgery, Fujian Cancer Hospital, Fujian Medical University, Fuzhou, China
| | - Zhentao Yu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Thoracic Surgery, Tianjin Cancer Hospital, Tianjin, China
| | - Zhirong Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Fang
- Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, China
| | - Donghong Fu
- Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, China
| | - Xudong Wei
- Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, China
| | - Ligong Yuan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shan Muhammad
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
8
|
Post-esophagectomy tracheobronchoesophageal fistula: management and results of a tertiary referral center. Updates Surg 2023; 75:435-449. [PMID: 35996059 DOI: 10.1007/s13304-022-01364-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF after esophagectomy and compare it with other reported series. Patients who developed a TBEF after esophagectomy were identified retrospectively. Baseline and intraoperative characteristics, postoperative and TBEF details, treatments for TBEF, and main outcomes are described. A univariate analysis was performed to compare some of the analyzed variables with the overall sample. Finally, our results are compared with the previously described series. Altogether, 16 patients with TBEF (3.11%) were analyzed from 514 patients who received esophagectomies between January 2014 and February 2020. As a first treatment attempt, 14 (87.5%) were treated with surgery, one was treated conservatively, and one was treated endoscopically. Surgery both at a first or second treatment attempt achieved a survival rate of 62.5% and oral intake at discharge of 43.75%. Six patients died during their hospital stay (37.5%). The presence of an anastomotic leak showed a strong association with TBEF development (100% vs. 19.7%; OR 1.163, 95% CI 1.080-1.253, p = 0.000). In our experience, surgical treatment as the first approach for TBEF associated with anastomotic leak after esophagectomy obtained good results. However, there is an urgent need to elaborate treatment guidelines based on international consensus.
Collapse
|
9
|
Cao J, Geng M, Huang X, Liu C, Li H. New improved incision-tubing approach for bronchoesophageal Fistula with mediastinal abscess after esophagectomy: A case report. Front Surg 2023; 10:1100264. [PMID: 36960212 PMCID: PMC10027923 DOI: 10.3389/fsurg.2023.1100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/16/2023] [Indexed: 03/09/2023] Open
Abstract
Bronchoesophageal fistula is a serious threat to the survival after esophagectomy for esophageal cancer. The erosion of mediastinal abscess post anastomotic leakage is the most likely directly cause. However, the bronchoesophageal fistula with gastric conduit necrosis and mediastinal abscess is refractory to either surgical or conservative treatment. In the article, a unique case of Bronchoesophageal fistula with mediastinal abscess after gastric conduit necrosis is presented. A 74-year-old female was detected the right inferior bronchus-esophageal fistula with mediastinal abscess on 15 postoperative day after esophagectomy for esophageal cancer. A successful new improved minimally invasive management was performed.
Collapse
Affiliation(s)
- Jianwei Cao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mingfei Geng
- Department of Thoracic Surgery, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Xiaoyu Huang
- Department of Thoracic Surgery, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Changjiang Liu
- Department of Thoracic Surgery, The Fuorth Hospital of Hebei Medical University, Shijiazhuang, China
- Correspondence: Changjiang Liu Hui Li
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Correspondence: Changjiang Liu Hui Li
| |
Collapse
|
10
|
Grass JK, Küsters N, von Döhren FL, Melling N, Ghadban T, Rösch T, Simon M, Izbicki JR, König A, Reeh M. Management of Esophageal Cancer-Associated Respiratory–Digestive Tract Fistulas. Cancers (Basel) 2022; 14:cancers14051220. [PMID: 35267527 PMCID: PMC8909259 DOI: 10.3390/cancers14051220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Respiratory–digestive tract fistulas are fatal complications that occur in esophageal cancer treatment. Interdisciplinary treatment strategies are still evolving, especially in anatomical treatment stratification. Thus, this study aims to evaluate general therapeutic strategies for this rare condition. Medical records were reviewed for esophageal cancer-associated respiratory–digestive tract fistula patients treated between January 2008 and September 2021. Fistulas were classified according to being surgery- and tumor-associated. Treatment strategies, clinical success, and survival were analyzed. A total of 51 patients were identified: 28 had tumor-associated fistulas and 23 surgery-associated fistulas. Risk factors for fistula development such as radiation (OR = 0.290, p = 0.64) or stent implantation (OR = 1.917, p = 0.84) did not correlate with lack of symptom control for RDF patients. In contrast, advanced lymph node metastasis as another risk factor was associated with persistent symptoms after treatment for RDF patients (OR = 0.611, p = 0.01). Clinical success significantly correlated with bilateral fistula repair in surgery-associated fistulas (p = 0.01), while tumor-associated fistulas benefited the most from non-surgical (p = 0.04) or combined surgical and non-surgical intervention (p = 0.04) and a bilateral fistula repair (p = 0.02) in terms of overall survival. The therapeutic strategy should aim for bilateral fistula closure. A multidisciplinary, stepwise approach might have the best chance for restoration or symptom control with optimized overall survival in selected patients.
Collapse
Affiliation(s)
- Julia K. Grass
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
- Correspondence: ; Tel.: +49-040-7410-52401
| | - Natalie Küsters
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Fabien L. von Döhren
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Marcel Simon
- Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Jakob R. Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Alexandra König
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| |
Collapse
|
11
|
Nakagawa Y, Makita S, Uchida H, Hinoki A, Shirota C, Sumida W, Amano H, Okamoto M, Takimoto A, Ogata S, Takada S, Kato D, Gohda Y, Guo Y. Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report. Front Pediatr 2022; 10:1053154. [PMID: 36619516 PMCID: PMC9811173 DOI: 10.3389/fped.2022.1053154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
A tracheoesophageal fistula (TEF) recurs in approximately 2%-13% of cases of esophageal atresia with TEF that are treated surgically. Currently, there is no consensus on the most effective treatment to prevent recurrent TEF (RTEF). Herein, we present a patient with type C esophageal atresia who underwent thoracoscopic esophago-esophageal anastomosis and TEF repair at 2 days old. However, RTEFs were observed at ages 3, 6, and 11 months, and thoracoscopic TEF repairs using a pleural patch, fascia lata graft, and pectoralis major myocutaneous (PMMC) flap were performed, respectively. A fourth recurrence led to mediastinitis, shock liver, disseminated intravascular coagulopathy, and a compromised respiratory status. Hence, laparoscopic esophageal transection was first performed to improve the respiratory condition by preventing the regurgitation of gastric contents. Once the patient was stable, a subtotal esophageal resection with TEF closure followed by gastric tube reconstruction was performed. In conclusion, we encountered a case of refractory RTEF that was repaired four times using various techniques, including a fascia lata graft and PMMC flap. However, TEF still recurred after these four operations. The final surgical strategy involved an esophageal transection as a palliative therapy, which improved the respiratory condition, followed by closure of the TEF and subtotal esophageal resection. Finally, esophageal reconstruction using a gastric tube after the complete remission of inflammation was effective. This multi-stage surgery was considered the only choice to rescue the patient and effectively prevent another recurrence.
Collapse
Affiliation(s)
- Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinari Hinoki
- Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiya Ogata
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yousuke Gohda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
12
|
Sato Y, Tanaka Y, Suetsugu T, Takaha R, Ojio H, Hatanaka Y, Imai T, Okumura N, Matsuhashi N, Takahashi T, Kato H, Yoshida K. Three-step operation for esophago-left bronchial fistula with respiratory failure after esophagectomy: a case report with literature review. BMC Gastroenterol 2021; 21:467. [PMID: 34906075 PMCID: PMC8672548 DOI: 10.1186/s12876-021-02051-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
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.
Collapse
Affiliation(s)
- Yuta Sato
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan.
| | - Tomonari Suetsugu
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Ritsuki Takaha
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Hidenori Ojio
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Yuji Hatanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Takeharu Imai
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Naoki Okumura
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Takao Takahashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Hisakazu Kato
- Department of Plastic and Reconstructive Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| |
Collapse
|
13
|
Shan Q, Huang W, Shang M, Wang Z, Xia N, Xue Q, Mao A, Ding X, Wang Z. Treatment of aerodigestive fistulas with a novel covered metallic Y-shaped segmented airway stent customized with the assistance of 3D printing. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1051. [PMID: 34422963 PMCID: PMC8339849 DOI: 10.21037/atm-21-733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/02/2021] [Indexed: 11/12/2022]
Abstract
Background The management of aerodigestive fistula remains challenging. An airway stent that matches well with the individual geometry of the airway is needed for the treatment of the aerodigestive fistula. This study aimed to evaluate the feasibility of a novel covered metallic segmented Y-shaped airway stent customized with the assistance of 3D printing in aerodigestive fistulas involving the carina and distal bronchi and to compare the flexibility of the novel stent with the conventional wholly knitted stent. Methods In the flexibility study, we measured the longitudinal bending force and spring-back force of the segmented stent and wholly knitted stent. Patient-specific stents that were individually customized with the assistance of 3D printing technology were implanted in 26 patients with aerodigestive fistulas. The technical success, clinical success, Karnofsky performance status (KPS), and stent-related complications were recorded. Results The bending force and spring-back force of the segmented stent were significantly lower than those of the wholly knitted stent. Stent deployment was technically successful in all patients. Clinical success was obtained in 21 patients. The KPS of patients after the stenting procedure improved significantly compared with that before stenting (P<0.001). During follow-up, granulation tissue proliferation, sputum retention, stent migration, and intolerance of the stent were found in 2, 5, 1, and 1 patient, respectively. Conclusions The segmented metallic Y-shaped airway stent had greater flexibility than the wholly knitted stent in an ex vivo setting. Implantation of the segmented stent individually customized with the aid of 3D printing is feasible in treating aerodigestive fistulas involving the carina and bronchi distal to the carina.
Collapse
Affiliation(s)
- Qungang Shan
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Shang
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Xia
- Department of Radiology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingsheng Xue
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiwu Mao
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Radiology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
14
|
Khader Y, Ghazaleh S, Nehme C, Burlen J, Nawras A. Esophagopericardial Fistula After Esophagectomy. Cureus 2021; 13:e13753. [PMID: 33842130 PMCID: PMC8023974 DOI: 10.7759/cureus.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Esophagectomy is the mainstay surgical treatment for esophageal carcinoma. The operation can be complicated by an anastomotic stricture, anastomotic leak, recurrent laryngeal nerve injury, conduit ischemia, and chylothorax. Rarely, esophagectomy can be complicated by fistula formation between the gastrointestinal tract and the nearby structures. We describe a case of esophagopericardial fistula after esophagectomy. A 50-year-old man presented to the emergency room with a chest pain of two-week duration associated with sweating, chills, and poor appetite. He was diagnosed with stage III esophageal adenocarcinoma four months ago. He had received neoadjuvant chemotherapy followed by distal esophagectomy, partial gastrectomy, and placement of a jejunostomy tube one month before presentation. Cardiovascular examination was significant for jugular venous distention and distant heart sounds. Chest CT angiography showed pneumomediastinum concerning for anastomotic leak. Esophagram finally confirmed an esophagopericardial fistula. A drain was placed into the pericardial space followed by emergent esophageal stent placement. Eventually, he underwent a cervical esophagostomy and placement of a jejunostomy tube. The patient was later discharged home in a stable condition. In conclusion, esophagopericardial fistula is a rare adverse event of esophagectomy. Esophageal stenting could be useful as a temporary or definite treatment.
Collapse
Affiliation(s)
- Yasmin Khader
- Department of Internal Medicine, University of Toledo, Toledo, USA
| | - Sami Ghazaleh
- Department of Internal Medicine, University of Toledo, Toledo, USA
| | - Christian Nehme
- Department of Internal Medicine, University of Toledo, Toledo, USA
| | - Jordan Burlen
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, USA
| |
Collapse
|
15
|
Sonomura J, Shimizu T, Taniguchi K, Lee SW, Tanaka R, Imai Y, Honda K, Kawai M, Tashiro K, Uchiyama K. Esophago-bronchial fistula treated by the Over-The-Scope-Clipping (OTSC) system with argon beam electrocoagulation: A case report. Medicine (Baltimore) 2021; 100:e24494. [PMID: 33530270 PMCID: PMC7850741 DOI: 10.1097/md.0000000000024494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE An esophago-bronchial fistula is one of the rare postoperative complications of esophageal cancer. There are various medical treatments, including suturing, endoscopic clip, and fibrin glue. However, these treatments often lead to unsatisfactory results, causing physicians to opt for surgical alternatives. The Over-The-Scope-Clipping (OTSC) system offers an alternative method for fistula closure. It can capture a large amount of tissue and is able to compress the lesion until it has fully healed. However, data indicating the efficacy of OTSC for esophago-bronchial fistula are limited. PATIENT CONCERNS A 64-year-old man presented with an esophago-bronchial fistula after surgery for esophageal cancer. We chose to use a stent as the first line of treatment, but the fistula did not close. DIAGNOSES Intractable esophago-bronchial fistula associated with esophageal surgery. INTERVENTIONS AND OUTCOMES On the 94th postoperative day, fistula closure with OTSC was performed, and no leakage of the contrast agent was observed during fluoroscopy. We also attempted to close the fistula by combining OTSC and argon plasma coagulation (APC) to burn off the scar tissue from around the fistula. The fistula gradually shrank after a total of 4 rounds of OTSC, and closure of the fistula was achieved on the 185th postoperative day. There were no adverse events during the treatment of this case. LESSONS We demonstrate that OTSC is useful in the management of esophago-bronchial fistulas, and may become a standard procedure for the endoscopic treatment of esophago-bronchial fistulas, replacing the use of stents, clips, or glue.
Collapse
Affiliation(s)
- Jun Sonomura
- Department of General and Gastroenterological Surgery
| | | | - Kohei Taniguchi
- Department of General and Gastroenterological Surgery
- Translational Research Program, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki city, Osaka, Japan
| | | | - Ryo Tanaka
- Department of General and Gastroenterological Surgery
| | - Yoshiro Imai
- Department of General and Gastroenterological Surgery
| | - Kotaro Honda
- Department of General and Gastroenterological Surgery
| | - Masaru Kawai
- Department of General and Gastroenterological Surgery
| | | | | |
Collapse
|
16
|
Chung YJ, Kim JH, Kim DJ, Kim JJ. Successful Management of a Tracheo-gastric Conduit Fistula after a Three-field Esophagectomy with Combined Sternocleidomastoid Muscle Rotation Flap and Histoacryl Injection Treatment. J Gastric Cancer 2020; 20:454-460. [PMID: 33425446 PMCID: PMC7781752 DOI: 10.5230/jgc.2020.20.e38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/19/2020] [Accepted: 12/19/2020] [Indexed: 01/19/2023] Open
Abstract
Tracheo-gastric conduit fistula is an extremely rare but severe complication that is difficult to manage. Conservative care, esophageal or tracheal stent placement, or cutaneomuscular flaps have been suggested; however, no definite treatment has been proven. We report a case of tracheo-gastric conduit fistula that occurred after a minimally invasive radical three-field esophagectomy. Following the primary surgery, the diagnosis was made while evaluating the patient's frequent aspiration and coughing. Conservative management failed, and a surgical correction was undertaken to identify the multifocal mucosal defect and exposed tracheal ring. A sternocleidomastoid muscle rotation flap and subsequent Histoacryl injection into the remaining fistula were performed, and the fistula was successfully managed.
Collapse
Affiliation(s)
- Yoon Ji Chung
- Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Kim
- Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jin Jo Kim
- Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
17
|
Takahashi N, Fuchimoto Y, Mori T, Abe K, Yamada Y, Koinuma G, Kuroda T. Post-esophageal atresia repair double acquired tracheoesophageal fistulas treated successfully by gastric transposition: a case report. Surg Case Rep 2020; 6:224. [PMID: 32975613 PMCID: PMC7519015 DOI: 10.1186/s40792-020-01004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/19/2020] [Indexed: 11/27/2022] Open
Abstract
Background Postoperative recurrence of tracheoesophageal fistula (TEF) is a frequent complication in the repair of esophageal atresia (EA). Based on the recent etiologic classification, a TEF that develops in a different new pathway from the original one is categorized as an acquired TEF. The TEFs that fall into this category have been reported to be refractory and their mechanisms have not been fully understood. Here, we report the complicated case of an acquired TEF derived from mediastinitis after the original TEF repair developed an anastomotic stricture. The TEF contained double fistulas, both towards the right lobe bronchi, and was repaired by gastric transposition through a retrosternal route. Case presentation The patient was diagnosed with Gross C esophageal atresia after birth and underwent tracheoesophageal fistula banding during the neonatal period. He experienced an intractable anastomotic stenosis after surgery which was treated with repeated balloon dilation therapy. By the age of 11 months, he developed a mediastinal abscess that improved with conservative treatment. At 18 months old, a fistula from the esophagus to the right superior lobe bronchus was identified. The patient underwent a right upper lobectomy to resect the fistula. However, at 21 months old, another fistula to the right lower lobe was revealed. An esophageal banding was done to relieve the respiratory symptoms. This was followed by esophagectomy and gastric transposition through the retrosternal route at 26 months old. The patient started rehabilitation and oral intake gradually after surgery. By 3 years after gastric transposition, he could already take blended food orally with the support of small amounts of enteral feeding. Conclusion Cases of TEF derived from severe inflammation have the potential to form a complicated network and lead to recurrence. Surgeons should consider the possibility of multiple tiny fistulas in cases of severe acquired TEF. These may be repaired successfully by gastric transposition through the retrosternal route.
Collapse
Affiliation(s)
- Nobuhiro Takahashi
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Fuchimoto
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan. .,Department of Pediatric Surgery, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, Japan.
| | - Teizaburo Mori
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kiyotomo Abe
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Goro Koinuma
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.,Pediatric Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
18
|
Wang C, Li C, Yang X, Mao W, Jiang Y, Wu J, Zhao Q, Ji A, Chen Q, Li H, Liu J. The classification and treatment strategies of post-esophagectomy airway-gastric fistula. J Thorac Dis 2020; 12:3602-3610. [PMID: 32802439 PMCID: PMC7399427 DOI: 10.21037/jtd-20-284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Airway-gastric fistulas (AGFs) are rare but life-threatening complications after esophagectomy for esophageal cancer. Their effective and reasonable management is challenging and still controversial. This study reports the classification and management strategies of post-esophagectomy AGF based on a retrospective analysis of 26 cases in two large volume centers in China. Methods Between January 2000 and December 2017, 6,316 consecutive patients with esophageal carcinoma underwent esophagectomy. AGF was verified in 26 patients. The patients with AGF were divided into two types based on the anatomic characteristics of the fistula. Type I was characterized by the presence of fistula orifices in digestive tract that were higher than those in the airway and were treated with conservative management. Type II had both fistula orifices located on the same horizontal plane and were treated with surgical management. Pearson Chi-Square (R software) was used to compare mortality rates. Results From January 2000 and December 2017, 26 cases occurred AGF in 6,316 consecutive patients with esophageal carcinoma underwent esophagectomy and the incidence of AGF was 0.4%. Ten of 12 patients with type I AGF survived. Nine of 14 patients with type II AGF died. There was a significantly difference in the mortality rates between patients with AGF type I and II, which was 16.7% (2/12) and 64.3% (9/14) (χ2=6.003, P=0.014), respectively. Conclusions AGF may be classified into two types according to the anatomic characteristics. Type I patients may be cured by conservative management and type II patients, require surgical intervention with pedicled tissues flap wrapping of the airway.
Collapse
Affiliation(s)
- Changchun Wang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Chengqiang Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xun Yang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Weimin Mao
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Youhua Jiang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jie Wu
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Qiang Zhao
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Anqi Ji
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qixun Chen
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinshi Liu
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| |
Collapse
|
19
|
Abstract
Esophagectomy is a complex operation with many potential complications. Early recognition of postoperative complications allows for the best chance for patient survival. Diagnosis and management of conduit complications, including leak, necrosis, and conduit-airway fistulae, are reviewed. Other common complications, such as chylothorax and recurrent laryngeal nerve injury, also are discussed.
Collapse
Affiliation(s)
- Jonathan C Yeung
- Toronto General Hospital, 200 Elizabeth Street 9N-983, Toronto, Ontario M5G 2C4, Canada.
| |
Collapse
|
20
|
Zhang YH, Du J, Li CH, Hu B. Endoscopic pedicle flap grafting in the treatment of esophageal fistulas: A case report. World J Clin Cases 2020; 8:2359-2363. [PMID: 32548168 PMCID: PMC7281058 DOI: 10.12998/wjcc.v8.i11.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/15/2020] [Accepted: 05/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fistulization is a rare complication of esophageal diverticula. Patients with this condition often require surgery, which unfortunately can be invasive and traumatic. Endoscopic therapy is an alternative method for treating esophageal fistula. Hereby we introduce a new endoscopic technique that uses an esophageal pedicle flap to close esophageal fistulas.
CASE SUMMARY A 49-year-old male patient, complaining of backache and choking, was formerly diagnosed with chronic bronchopneumonia. Chest computed tomography and esophagram confirmed the presence of esophageal diverticulum and mediastinal esophageal fistula. The patient was then treated by covering the fistulas using a pedicled flap that was acquired through endoscopic submucosal dissection of a patch from the proximal esophageal mucosa. Then the pedicle flap was reversed 180° to cover the fistula. Titanium clips were used to fix the flap. The procedure ended with percutaneous endoscopic gastrostomy for enteral nutrition. The patient was followed up to evaluate the size reduction of the fistula. Cough, backache, and fever were alleviated within a week. Forty-five days after the surgery, endoscopic examination showed that the fistulas were reduced in size. The larger one reduced from 0.5 cm to 0.2 cm, while the smaller one was fully closed.
CONCLUSION Transplantation of a pedicle flap obtained from the esophageal mucosa endoscopically is minimally invasive for the treatment of fistula.
Collapse
Affiliation(s)
- Yu-Hang Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jiang Du
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chuan-Hui Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
21
|
Commentary: Three-dimensional printing: More than a roadmap. J Thorac Cardiovasc Surg 2020; 161:1672. [PMID: 32334885 DOI: 10.1016/j.jtcvs.2020.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022]
|
22
|
Muniappan A, Mathisen DJ. Reply. Ann Thorac Surg 2019; 108:311-312. [PMID: 30898566 DOI: 10.1016/j.athoracsur.2019.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Ashok Muniappan
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit St, Founders 7, Boston, MA 02114.
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit St, Founders 7, Boston, MA 02114
| |
Collapse
|
23
|
Bergeat D, Bertheuil N, Meunier B. The Link Between Minimally Invasive Esophagectomy and Tracheobronchial Fistula Occurrence. Ann Thorac Surg 2019; 108:311. [PMID: 30629925 DOI: 10.1016/j.athoracsur.2018.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Damien Bergeat
- Department of Digestive Surgery, Centre Hospitalo-Universitaire, 2 Rue Henri le Guilloux, 35000 Rennes, France.
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructrive and Aesthetic Surgery, Centre Hospitalo-Universitaire, Rennes, France
| | - Bernard Meunier
- Department of Digestive Surgery, Centre Hospitalo-Universitaire, Rennes, France
| |
Collapse
|
24
|
Wang H, Tao M, Zhang N, Zou H, Li D, Ma H, Zhou Y. Single application of airway stents in thoracogastric-airway fistula: results and prognostic factors for its healing. Ther Adv Respir Dis 2019; 13:1753466619871523. [PMID: 31476949 PMCID: PMC6724482 DOI: 10.1177/1753466619871523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Thoracogastric-airway fistula (TGAF) post-thoracic surgery is a rare and challenging complication for esophagectomy. The aim of this study was to explore the effectiveness of airway stenting for TGAF patients and find related factors coupled with healing of fistula. METHODS This is a retrospective study involving patients with TGAF who were treated with airway stentings. Based on different TGAF locations and sizes on chest computed tomography, covered metallic or silicon airway stents were implanted to cover orifices under interventional bronchoscopy. TGAF healing was defined as the primary outcome, and complete sealing of TGAF as the second outcome. The predictors for TGAF healing were analyzed in univariate and multivariate analysis. RESULTS A total of 58 TGAF patients were included, of whom 7 received straight covered metallic stents, 5 straight silicon stents, 3 L-shaped covered metallic stents, 21 large Y-shaped covered metallic stents, 17 large Y-shaped silicon stents, and 5 with Y-shaped covered metallic stents. Healing was achieved in 20 (34.5%) patients, and complete sealing in 45 (77.6%) patients. There were no significant differences in healing rate and complete sealing rate between patients receiving metallic stents and those with silicon stents. In univariate analysis, lacking a previous history of radiotherapy or chemotherapy, nonmalignant fistulas, small fistulas, and shorter postesophagectomy duration were found associated with a higher rate of TGAF healing. Only shorter postesophagectomy duration was associated with TGAF healing in multivariate analysis. CONCLUSIONS Both silicon and covered metallic airway stenting are effective methods to close TGAF. A shorter postesophagectomy period may predict better TGAF healing. The reviews of this paper are available via the supplemental material section.
Collapse
Affiliation(s)
- Hongwu Wang
- Department of Oncology, Emergency General Hospital, No. 29 Xibahe Nanli, Chaoyang District, Beijing, 100028, China
| | - Meimei Tao
- Department of Oncology, Emergency General Hospital, No. 29 Xibahe Nanli, Chaoyang District, Beijing, 100028, China
| | - Nan Zhang
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Hang Zou
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Dongmei Li
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Hongming Ma
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Yunzhi Zhou
- Department of Oncology, Emergency General Hospital, Beijing, China
| |
Collapse
|