Arteriotracheale Fistel als schwere Komplikation nach Trachearesektion und hyperfraktionierter Radiatio wegen eines Schilddrüsenkarzinoms

Abstract

cheostomie. Background: The arteriotraeheal fistula is a severe, and mostly fatal complication in the treatment of patients with head and neck cancer. Methods: We report a case of fatal haemorrhage from a fistula between the right brachiocephalic trunk and the trachea after radical thyroidectomy, resection of the frontal wall of the cervical trachea, and twice-a-day-irradiation. Results: Compared to conventional irradiation therapy, twice-a-day-irradiation seems to be the major cause of this fatal complication. Conclusions: Therefore we prefer conventional irradiation therapy to twice-aday-irradiation in patients with R0 resection (curative tumor removal) and reconstructive surgery of the trachea and/or esophagus. In patients where R0 resection is impracticable, a reconstructive approach to the trachea or esophagus has to be avoided. In these cases, early postoperative twice-a-day-irradiation may prevent early tumor recurrence. (Acta Chir. Austriaca 1993;25:278-282)