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Zhang C, Sun Z, Song M, Liu Y, Xu K, Han X, Jiao D. Effectiveness and safety of a ventricular septal occluder device for the treatment of Gastro-tracheal fistula. Clin Radiol 2024; 79:697-703. [PMID: 38866677 DOI: 10.1016/j.crad.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Gastro-tracheal fistula (GTF) is one of the most serious complications after esophagogastrostomy and radiotherapy, with very high disability and mortality rates. To evaluate the effectiveness and safety of ventricular septal occluder devices (VSOD) for the treatment of Gastro-tracheal fistula (GTF). METHODS From January 2020 to May 2022, 14 patients with GTF underwent VSOD under real-time fluoroscopy. The technical success, complications, quality of life (QoL), Eastern Cooperative Oncology Group (ECOG) score, Karnofsky score, and median overall survival (mOS) were recorded and analyzed. RESULTS Technical success, and major complication rates were 71.4%, and 14.3%, respectively. Both the ECOG and the Karnofsky score showed significant improvement at the 2-month evaluation compared with the pretreatment value (p<0.05). For QoL, general health, physical function, vitality, role physical, and social function all improved at the 2-month evaluation (p<0.05), but bodily pain, role emotion, and mental health showed no significant difference (P>0.05). During the mean follow-up of 9.6 months, eight patients were alive, and the mOS was 11.4 months (95% CI, 8.5-14.3). CONCLUSIONS VSOD is a simple and safe technique for GTF treatment, but long-term observation is needed at multiple centers to confirm our findings.
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Affiliation(s)
- C Zhang
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - Z Sun
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - M Song
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - Y Liu
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - K Xu
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - X Han
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - D Jiao
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China.
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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.
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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
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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.
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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
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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.
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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;
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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.
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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
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Tao M, Zhang N, Wang H, Ma H, Gao H, Wang Z. Bronchial arterial embolization may reduce the risk of severe bleeding in central airway obstruction due to renal cell carcinomas during bronchoscopic procedures. Ther Adv Respir Dis 2020; 14:1753466620976012. [PMID: 33272105 PMCID: PMC7720307 DOI: 10.1177/1753466620976012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hemorrhage is a life-threatening complication during bronchoscopic intervention in patients with central airway obstruction (CAO) due to metastatic renal cell carcinoma (RCC). Whether pre-bronchoscopic bronchial arterial embolization (BAE) can reduce the risk of severe bleeding in CAO patients due to metastatic RCC remains unclear. METHODS A total of 31 CAO patients due to metastatic RCC were included retrospectively and divided into a BAE group (receiving pre-bronchoscopic BAE) and non-BAE group in this study. Based on computed tomography (CT) and bronchoscopic findings, tumor debulking was used to reconstruct the airway during interventional bronchoscopy. The primary outcome was the incidence of severe bleeding during bronchoscopic procedures. Bleeding-related complications, Karnofsky performance score (KPS) and dyspnea score were also analyzed over a 1-month observation period. RESULTS There were no significant differences between the two groups in baseline characteristics, including patients' features, tumor morphology under CT scannings, tumor site, and obstruction degree under bronchoscopic examination. Procedure-related bleeding occurred in all 31 patients. Pre-bronchoscopic BAE significantly reduced the incidence of moderate and major bleeding when compared with that in the non-BAE group. The incidence of poor visualization and hypoxia was also reduced significantly in the BAE group. There was no significant difference in KPS and dyspnea score between the BAE and non-BAE groups at 1 month follow up. CONCLUSION Pre-bronchoscopic BAE might be a feasible option to reduce the risk of severe bleeding for CAO patients due to metastatic RCC during bronchoscopic intervention. Interventional bronchoscopy was a safe and effective procedure for CAO due to metastatic RCC.The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Meimei Tao
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Nan Zhang
- Department of Oncology, Emergency General Hospital, No. 29 Xibahe Nanli, Chaoyang District, Beijing, 100028, China
| | - Hongwu Wang
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Hongming Ma
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Hong Gao
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Zhina Wang
- Department of Oncology, Emergency General Hospital, Beijing, China
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