The clinical characteristics, treatments and prognosis of post-esophagectomy airway fistula: a multicenter cohort study

Bin Zheng; Taidui Zeng; Hong Yang; Xuefeng Leng; Yong Yuan; Liang Dai; Xufeng Guo; Yan Zheng; Maohui Chen; Kai Zheng; Shuliang Zhang; Guanglei Huang; Wei Zheng; Kassem Harris; Chun Chen

doi:10.21037/tlcr-22-141

The clinical characteristics, treatments and prognosis of post-esophagectomy airway fistula: a multicenter cohort study

Transl Lung Cancer Res. 2022 Mar;11(3):331-341. doi: 10.21037/tlcr-22-141.

Authors

Bin Zheng^#^{1

2}, Taidui Zeng^#^{1

2}, Hong Yang³, Xuefeng Leng⁴, Yong Yuan⁵, Liang Dai⁶, Xufeng Guo⁷, Yan Zheng⁸, Maohui Chen^{1

2}, Kai Zheng⁴, Shuliang Zhang^{1

2}, Guanglei Huang^{1

2}, Wei Zheng^{1

2}, Kassem Harris⁹, Chun Chen^{1

2}

Affiliations

¹ Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China.
² Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
³ Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
⁴ Division of Thoracic Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China.
⁵ Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
⁶ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China.
⁷ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁸ Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou, China.
⁹ Division of Pulmonary Critical Care, Department of Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.

^# Contributed equally.

Abstract

Background: Post-esophagectomy airway fistula (PEAF) is a serious complication after esophageal cancer resection. At present, the clinical characteristics, treatments and prognosis of PEAF patients remain inconclusive. We aimed to investigate these problems of patients with PEAF through a multi-center retrospective cohort study.

Methods: We included consecutive patients who underwent esophagectomy for esophageal cancer in seven major Chinese esophageal cancer centers from January 2010 to December 2020. Based on the anatomic characteristics of PEAF patients, PEAFs were divided into Union type I (without digestive fistula) and Union type II [respiratory-digestive fistula (RDF)], and subtypes a and b (tracheal or bronchial fistulas), as well as L1 and L2 (same or different level of fistulas). The clinical characteristics, diagnoses, managements, and effects of the various types were retrospectively analyzed.

Results: PEAF occurred in 85 of 26,608 patients (0.32%), including eight females and 77 males. There were 16 patients with type I and 69 with type II. The numbers of healings, non-healings, and deaths at discharge were 45 (52.9%), 20 (23.5%), and 20 (23.5%), respectively. Type Ib was common in type I, and type II L1 was common in type II. The healing rates of surgical, stent, and conservative treatments were 50%, 60%, and 50%, respectively. All type I patients treated with stent implantation were healed at discharge. The healing rates, mortality, and 3-year survival of type II L1 and type II L2 patients were 55.4% and 30.8%, 17.9% and 30.8%, and 34.3% and 15.4%, respectively. The 5-year survival rates of all PEAFs were 21.1%.

Conclusions: PEAF is an infrequent and life-threatening complication after esophagectomy. Patients with different types of PEAF often have different inducements. In this study, we found that the healing rates of surgical and conservative treatments were similar, and stent implantation may have the potential to improve efficacy. Type II L2 patients were the most difficult to cure.

Keywords: Esophageal cancer; aerodigestive fistula; post-esophagectomy airway fistula (PEAF); tracheobronchial fistula (TBF).