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Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome
H E Bartels1, H J Stein, J R Siewert
1Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technischen Universität München, Germany.
Background:
Lesions of the trachea or main-stem bronchi with air leakage are a grave complication of oesophagectomy.
Methods:
Prevalence, predisposing factors and outcome of non-malignant lesions of the trachea or main-stem bronchi were analysed retrospectively in a consecutive series of 785 patients who had oesophagectomy for oesophageal cancer.
Results:
Overall 31 of 785 patients developed a tracheobronchial fistula 1-30 days after oesophagectomy. Based on the location of the lesions and clinical circumstances, the tracheobronchial fistulas were thought to be due to surgical injury (four patients), cuff pressure of the tracheostomy tube (two), local peritracheal infection resulting from a cervical anastomotic leak (seven) or 'ischaemia' after extensive peritracheal dissection (18). On multivariate analysis, transthoracic en bloc resection (P < 0.01) and preoperative radiochemotherapy for locally advanced tumours located at or above the level of the tracheal bifurcation (P < 0.01) predisposed to this complication.
Conclusion:
Non-malignant tracheobronchial lesions are a serious complication of transthoracic oesophagectomy with extensive lymph node dissection, particularly in patients undergoing preoperative radiochemotherapy for locally advanced tumours.