Surgical cervicothoracic-flap repair of neoesophagus-airway fistula after esophagectomy for esophageal cancer: A retrospective cohort study

Thibaud Bertrand; Olaf Mercier; Nicolas Leymarie; Justin Issard; Jean-François Honart; Dominique Fabre; Frédéric Kolb; Elie Fadel

doi:10.1016/j.xjtc.2023.10.027

Surgical cervicothoracic-flap repair of neoesophagus-airway fistula after esophagectomy for esophageal cancer: A retrospective cohort study

JTCVS Tech. 2023 Nov 14:23:123-131. doi: 10.1016/j.xjtc.2023.10.027. eCollection 2024 Feb.

Authors

Thibaud Bertrand¹, Olaf Mercier¹, Nicolas Leymarie², Justin Issard¹, Jean-François Honart², Dominique Fabre¹, Frédéric Kolb³, Elie Fadel¹

Affiliations

¹ Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France.
² Department of Reconstructive Surgery, Gustave Roussy, Villejuif, France.
³ Department of Reconstructive Surgery, University of California, San Diego, San Diego, Calif.

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.

Keywords: airway-gastric fistula; bronchial gastric fistula; bronchio-esophageal fistula; esophageal cancer; esophagectomy; gastrotracheal fistula; thoracogastric-airway fistula; tracheal stent; tracheobronchial fistula; tracheogastric fistula.