Management and outcomes of tracheobronchial injuries post-esophagectomy

Tracheobronchial injuries (TBI) are rare but potentially life-threatening complications of esophagectomy, with significant morbidity and mortality. This narrative review examined the incidence, risk factors, diagnostic methods, and management strategies for TBI following esophagectomy. A PubMed search was conducted for relevant studies published between 1978 and 2024 using terms related to tracheal injury and esophagectomy. Forty-five articles met the inclusion criteria. The incidence of TBI ranged from 0.4 to 3.5% in transhiatal esophagectomy (THE) and 0 to 2.67% in transthoracic esophagectomy (TTE). Identified risk factors included dense tumor adhesions, neoadjuvant chemoradiation, blunt esophageal dissection, and double-lumen endotracheal tube use. Diagnosis was primarily via bronchoscopy and imaging. Small, stable injuries were managed conservatively, while larger defects required surgical repair, often with muscle flap or synthetic reinforcement. Early intraoperative recognition and repair are key to improving outcomes, but mortality is high in cases of delayed diagnosis. This review emphasizes the importance of meticulous surgical technique, vigilant intraoperative monitoring, and individualized treatment strategies to minimize complications in high-risk patients.