Tracheobronchial fistula during the perioperative period of esophagectomy for esophageal cancer

Masaru Morita, Hiroshi Saeki, Tatsuro Okamoto, Eiji Oki, Sei Yoshida, Yoshihiko Maehara

研究成果: ジャーナルへの寄稿記事

7 引用 (Scopus)

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Background: Tracheobronchial (TB) injury and fistula formation during the perioperative period of esophagectomy is a rare but life-threatening complication. Methods: We examined the development of intraoperative TB injury and postoperative TB fistulas in consecutive 763 patients with esophageal cancer who underwent esophagectomy, including 494 patients who underwent transthoracic subtotal esophagectomy. Results: TB injury and fistulas developed in two (0.4 %) and four patients (0.8 %), respectively, who received transthoracic esophagectomy. TB injury developed during the dissection of a tumor invading a major airway. Direct suturing of the laceration and covering it using a muscle flap was effective for one patient, while additional repair with a major pectoral muscle flap was needed in another patient. Postoperative TB fistulas developed due to peri-tracheal infection in two patients, and conservative treatment with drainage was performed. In another two patients, gastro-tracheal fistulas developed due to mechanical compression of staplers on the gastric tube, which was elevated via the posterior mediastinal route. The direct repair of the gastric tube and covering it with a major pectoral muscle flap resulted in the resolution of these fistulas. Conclusion: Careful dissection with direct vision of the esophagus, as well as oversewing of the staplers on the gastric tube, is mandatory for preventing TB injury and fistula formation. Appropriate drainage is effective in cases with peri-tracheal abscesses. If the TB fistula fails to heal within a 4-to 6-week period, conservative management should be abandoned. Direct surgical intervention with coverage by a muscle flap is important for TB fistulas.

元の言語英語
ページ(範囲)1119-1126
ページ数8
ジャーナルWorld journal of surgery
39
発行部数5
DOI
出版物ステータス出版済み - 5 1 2015

All Science Journal Classification (ASJC) codes

  • Surgery

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