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

Abstract

ObjectiveTo evaluate outcomes of surgical repair of postesophagectomy neoesophagus–airway fistulas (NEAFs). MethodsWe retrospectively included consecutive patients with NEAF managed by various techniques at our center between August 2009 and July 2021. ResultOf 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. ConclusionsSurgical NEAF repair using perforator flap interposition may provide satisfactory long-term function after strong prehabilitation.