Intra- and Extrathoracic Malignant Tracheoesophageal Fistula-A Differentiated Reconstructive Algorithm

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Reconstructive Surgery

Background:

• Tracheoesophageal fistulae (TEF) pose significant challenges after oncologic resections and multimodal therapy.
• Prior radiation and procedures complicate wound healing, increasing complication rates.
• An interdisciplinary algorithm for TEF treatment was developed based on patient outcomes.

Purpose of the Study:

• To present an interdisciplinary algorithm for the treatment of tracheoesophageal fistulae (TEF).
• To evaluate the efficacy of various reconstructive techniques in managing complex TEF cases.
• To establish a differentiated reconstructive approach based on patient and disease characteristics.

Main Methods:

• Retrospective analysis of 18 patients treated for TEF between January 2015 and July 2017.
• Reconstructive techniques included pedicled flaps (Pectoralis major, Sternocleidomastoid, Latissimus dorsi, Intercostal Muscle) and free flaps (Anterolateral Thigh, Jejunum).
• Patients were categorized into extrathoracic, cervicothoracic, and intrathoracic TEF subgroups to guide treatment decisions.

Main Results:

• Primary reconstruction success rate was 61% (11/16 attempts), with an overall long-term success rate of 83% (15/18 patients).
• 30-day survival rate was 89%.
• An algorithm was developed, recommending pedicled flaps for primary extra- and cervicothoracic TEF, free flaps for recurrent cases, and ICM flaps for intrathoracic TEF.

Conclusions:

• Successful TEF reconstruction necessitates coordinated interdisciplinary efforts.
• A differentiated approach utilizing various reconstructive techniques, including pedicled and free flaps, leads to high success rates.
• Anticipating and managing patient-specific morbidity is crucial for optimal outcomes in complex TEF cases.