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Tracheobronchial Lesions Following Esophagectomy: Erosions, Ulcers, and Fistulae, and the Predictive Value of Lymph Node-Related Factors

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Following esophagectomy, tracheobronchial lesions (TBLs) can occur as a result of ischemia caused by extensive dissection around the tracheobronchus. In this study we assessed the causes and clinical features of these complications, paying particular attention to lymph node (LN)-related factors.


Between January 2000 and March 2007, 305 consecutive patients underwent subtotal esophagectomy using a transthoracic approach with LN dissection for thoracic esophageal cancer. TBLs, including erosions, ulcers, and fistulae, without traumatic injury during the operation, were detected during bronchoscopic examinations performed twice daily after the operation. The correlation between TBLs and tumor or surgical factors were analyzed.


TBLs were observed in 14 patients, accounting for an overall incidence of 5%; these included 6 fistulae, 5 ulcers, and 3 erosions. Cases with TBLs significantly more often involved three-field LN dissections (3FLD) than those without TBLs. Six (43%) patients with TBLs had more than four metastatic lymph nodes, while 9 (64%) had cervical and upper-mediastinal LN metastasis (p = 0.034 and 0.041, respectively). More than 60 LNs were dissected from 10 (71%) patients with TBLs (p = 0.021), and logistic regression analysis revealed that dissection of more than 60 lymph nodes and 3FLD were independent predictors of TBLs.


Esophageal cancer patients requiring extensive LN dissection of more than 60 nodes and/or 3FLD have an increased risk of developing a TBL during their postoperative course.

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Correspondence to Kiyotomi Maruyama.

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Maruyama, K., Motoyama, S., Sato, Y. et al. Tracheobronchial Lesions Following Esophagectomy: Erosions, Ulcers, and Fistulae, and the Predictive Value of Lymph Node-Related Factors. World J Surg 33, 778–784 (2009).

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