Tracheobronchial injury in the setting of an esophagectomy for cancer: Postoperative discovery a bad omen

Abstract

Patients with proximal tumors and radiation administration as a component of neoadjuvant treatment are more likely to suffer a tracheobronchial injury. An aggressive reoperative approach is warranted in patients with injuries that are discovered postoperatively.

Potential risk factors and outcomes of fistulas between the upper intestinal tract and the airway following Ivor-Lewis esophagectomy

“…Radiotherapy to the neck region for example might be associated with an increased risk of wound complications after head and neck surgery, 12,25 increased adhesions with more difficult dissection of the esophagus 3 and higher rates of intraoperative tracheobronchial injury. 4,26 Most importantly, a number of studies suggested that radiotherapy leads to increased interstitial fibrosis and congestion of the lungs, 27 and decreased irradiated lung volume might influence and increase the risk of postoperative complications. [28][29][30] Our study presents some limitations that have to be considered for proper interpretation of our results.…”

Surgical Management of Post-Esophagectomy Tracheo-Bronchial-Esophageal Fistula

“…The median time between esophagectomy and surgical repair of PETEF was 61 days (range, 7 days to 28 years). Anastomotic leak or gastric conduit necrosis was responsible for PETEF in 6 patients (54.5%), whereas other causes were erosion of a tracheal appliance (n [ 2), gastric conduit staple line erosion (n [ 1), anastomotic stricture dilation (n [ 1), and recurrent esophageal cancer (n [ 1). Membranous airway defects were repaired primarily and buttressed with muscle or omental flaps in 8 patients (72.7%), whereas two (18.2%) were repaired with bio-prosthetic patches and one (9.1%) was repaired with a sleeve resection of the bronchus.…”

Robotic Intraoperative Tracheobronchial Repair during Minimally Invasive 3-Stage Esophagectomy

“…Multiple risk factors are associated with the occurrence of this uncommon, but potentially fatal complication. In the case presented, repeated double-lumen intubation [2] and sclerotic changes of esophagealtracheal muscle fibers after neoadjuvant chemoradiotherapy for the treatment of advanced middle-third ESCC played a decisive role [1]. Furthermore, the latter condition led to inflammation and local edema, making esophageal dissection and extended mediastinal lymphadenectomy quite difficult to perform [1].…”

“…In the case presented, repeated double-lumen intubation [2] and sclerotic changes of esophagealtracheal muscle fibers after neoadjuvant chemoradiotherapy for the treatment of advanced middle-third ESCC played a decisive role [1]. Furthermore, the latter condition led to inflammation and local edema, making esophageal dissection and extended mediastinal lymphadenectomy quite difficult to perform [1]. Given this background, the inevitable traction and the effect of thermal cautery during the dissection may have contributed to the extent of both injuries.…”

“…Tracheobronchial injury (TBI) during esophagectomy is a rare complication that occurs in only 0.6% to 3.9% of cases but is associated with significant morbidity and mortality [1]. In the literature, a multifactorial origin of these iatrogenic tears has been proposed, including both anatomical and mechanical risk factors [2].…”