Post-esophagectomy tracheobronchoesophageal fistula: management and results of a tertiary referral center.

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.

• Authors: Eider Talavera-Urquijo, Paolo Parise, Agnese Carresi, Andrea Cossu, Lavinia Barbieri, Francesco Puccetti, Ugo Elmore, Riccardo Rosati
• Journal: Updates in surgery (Updates Surg) Vol. 75 Issue 2 Pg. 435-449 (Feb 2023) ISSN: 2038-3312 [Electronic] Italy
• PMID: 35996059 (Publication Type: Journal Article)
• Copyright: © 2022. Italian Society of Surgery (SIC).

Topics

• Humans
• Anastomotic Leak (etiology, surgery)
• Esophagectomy (adverse effects, methods)
• Retrospective Studies
• Tertiary Care Centers
• Esophageal Neoplasms (surgery)
• Esophageal Fistula (etiology, surgery)
• Anastomosis, Surgical (adverse effects)