Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort studyCentral MessagePerspective
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 ...
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Elsevier
2024-02-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723004108 |
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| author | Thibaud Bertrand, MD Olaf Mercier, MD, PhD Nicolas Leymarie, MD Justin Issard, MD Jean-François Honart, MD Dominique Fabre, MD, PhD Frédéric Kolb, MD Elie Fadel, MD, PhD |
| author_facet | Thibaud Bertrand, MD Olaf Mercier, MD, PhD Nicolas Leymarie, MD Justin Issard, MD Jean-François Honart, MD Dominique Fabre, MD, PhD Frédéric Kolb, MD Elie Fadel, MD, PhD |
| author_sort | Thibaud Bertrand, MD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-5ac950db3b764ed5a5ca711d02c55301 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-5ac950db3b764ed5a5ca711d02c553012025-08-20T03:38:23ZengElsevierJTCVS Techniques2666-25072024-02-012312313110.1016/j.xjtc.2023.10.027Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort studyCentral MessagePerspectiveThibaud Bertrand, MD0Olaf Mercier, MD, PhD1Nicolas Leymarie, MD2Justin Issard, MD3Jean-François Honart, MD4Dominique Fabre, MD, PhD5Frédéric Kolb, MD6Elie Fadel, MD, PhD7Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, FranceDepartment of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France; Address for reprints: Olaf Mercier, MD, PhD, Service de Chirurgie Thoracique et Transplantation cardio-pulmonaire, Hôpital Marie Lannelongue, 133 Ave de la Resistance, Le Plessis-Robinson, 92350, France.Department of Reconstructive Surgery, Gustave Roussy, Villejuif, FranceDepartment of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, FranceDepartment of Reconstructive Surgery, Gustave Roussy, Villejuif, FranceDepartment of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, FranceDepartment of Reconstructive Surgery, University of California, San Diego, San Diego, CalifDepartment of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, FranceObjective: 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.http://www.sciencedirect.com/science/article/pii/S2666250723004108airway-gastric fistulatracheobronchial fistulagastrotracheal fistulabronchio-esophageal fistulabronchial gastric fistulathoracogastric-airway fistula |
| spellingShingle | Thibaud Bertrand, MD Olaf Mercier, MD, PhD Nicolas Leymarie, MD Justin Issard, MD Jean-François Honart, MD Dominique Fabre, MD, PhD Frédéric Kolb, MD Elie Fadel, MD, PhD Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort studyCentral MessagePerspective JTCVS Techniques airway-gastric fistula tracheobronchial fistula gastrotracheal fistula bronchio-esophageal fistula bronchial gastric fistula thoracogastric-airway fistula |
| title | Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort studyCentral MessagePerspective |
| title_full | Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort studyCentral MessagePerspective |
| title_fullStr | Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort studyCentral MessagePerspective |
| title_full_unstemmed | Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort studyCentral MessagePerspective |
| title_short | Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort studyCentral MessagePerspective |
| title_sort | surgical cervicothoracic flap repair of neoesophagus airway fistula after esophagectomy for esophageal cancer a retrospective cohort studycentral messageperspective |
| topic | airway-gastric fistula tracheobronchial fistula gastrotracheal fistula bronchio-esophageal fistula bronchial gastric fistula thoracogastric-airway fistula |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723004108 |
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