Acquired Nonmalignant Tracheoesophageal Fistula: Changing Causes and Surgical Methods Over 40 Years

Area of Science:

• Thoracic surgery
• Otolaryngology
• Surgical oncology

Background:

• Acquired non-malignant tracheoesophageal fistula (ANM-TEF) is a rare, life-threatening condition with poorly established management protocols.
• Historical data on ANM-TEF causes, surgical interventions, and patient outcomes are limited.

Purpose of the Study:

• To analyze the evolution of ANM-TEF over four decades (1981-2022).
• To compare changes in etiological factors, surgical treatments, and patient outcomes between two distinct periods (1981-2007 and 2008-2022).

Main Methods:

• Retrospective analysis of 90 consecutive patients undergoing surgical ANM-TEF repair.
• Comparison of patient cohorts from early (1981-2007, n=48) and recent (2008-2022, n=42) periods.
• Evaluation of causes, surgical techniques, flap reconstruction use, and postoperative outcomes.

Main Results:

• Intubation decreased as a cause of ANM-TEF (91.7% to 21.4%), while laryngeal cancer treatment and esophageal procedures increased.
• Fasciocutaneous perforator flap use rose significantly (2.1% to 66.7%) due to increased local tissue damage.
• Initial fistula closure was successful in 86.6% of patients, with 90-day mortality at 13.3% and no significant group difference.

Conclusions:

• Laryngeal and esophageal surgery are now the primary causes of ANM-TEF, replacing intubation.
• Despite more severe local tissue damage in recent cases, surgical outcomes have been maintained.
• Advancements in surgical techniques, including fasciocutaneous flap reconstruction, are crucial for successful ANM-TEF management.