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Retrospective Analyses of Esophageal Bypass Surgery for Patients with Esophagorespiratory Fistulas Caused by Esophageal Carcinomas

World Journal of Surgery volume 40, pages 1158–1164 (2016)Cite this article

Abstract

Background

Esophagorespiratory fistula (ERF) caused by esophageal carcinoma is a fatal complication. In our institution, esophageal bypass surgery has been indicated when possible. We herein retrospectively describe the clinical results of esophageal bypass surgery for ERF.

Patients and methods

Between April 2001 and March 2015, 20 patients with ERF underwent esophageal bypass surgery. For these patients, the clinical safety, validity, and effectiveness of esophageal bypass surgery were examined and compared with the results of bypass surgery without ERF.

Results

Eight patients developed ERF at the initial diagnosis, while 10 patients developed ERF during and after chemoradiotherapy. Postoperative complications such as pneumonia, surgical site infection, and anastomotic leakage developed in 12, 5, and 1 patient, respectively. All the patients could eat solid foods at a median of 9 postoperative days. Two patients died within 30 days after the operation and 1 patient developed in-hospital death. Fourteen patients received chemo(radio)therapy after the operation. The median overall survival was 244 days and the one-year and three-year overall survival rates were 45.7 and 15.3 %, respectively. There was no significant difference in terms of the intraoperative findings, postoperative morbidities, and short-term and long-term clinical results between the two groups.

Conclusion

Esophageal bypass surgery for ERF is not considered to be highly invasive or risky compared with bypass surgery without ERF. After the operation, respiratory symptoms caused by ERF may improve and oral intake can be achieved. Esophageal bypass surgery should therefore be aggressively performed for patients with a tolerable performance status.

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References

  1. Ishida K, Iizuka T, Ando N et al (1996) Phase II study of chemoradiotherapy for advanced squamous cell carcinoma of the thoracic esophagus: nine Japanese institutions trial. Jpn J Clin Oncol 26:310–315

    CAS  Article  PubMed  Google Scholar 

  2. Hihara J, Hamai Y, Emi M et al (2014) Esophageal bypass operation prior to definitive chemoradiotherapy in advanced esophageal cancer with tracheobronchial invasion. Ann Thorc Surg 97:290–295

    Article  Google Scholar 

  3. Shinoda M, Ando N, Kato K et al (2015) Randomized study of low-dose versus standard-dose chemoradiotherapy for unresectable esophageal squamous cell carcinoma (JCOG0303). Cancer Sci 106:407–412

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Kato N, Tadanori H, Tanaka K et al (2000) Aortoesophageal fistula-relief of massive hematemesis with an endovascular stent-graft. Eur J Radiol 34:63–66

    CAS  Article  PubMed  Google Scholar 

  5. Ichiyoshi Y, Kawahara H, Taga S et al (1999) Indications and operative techniques for combined aortoesophageal resection. Jpn J Thorac Cardiovasc Surg 47:318–324

    CAS  Article  PubMed  Google Scholar 

  6. Low DE, Kozarek RA (1998) Comparison of conventional and wire mesh expandable prostheses and surgical bypass in patients with malignant esophagorespiratory fistulas. Ann Thorac Surg 65:919–923

    CAS  Article  PubMed  Google Scholar 

  7. Kishi K, Nakao T, Goto H et al (2005) A fast placement technique for covered tracheobronchial stents in patients with complicated esophagorespiratory fistulas. Cardiovasc Intervent Radiol 28:485–489

    Article  PubMed  Google Scholar 

  8. van den Bongard HJ, Boot H, Baas P et al (2002) The role of parallel stent insertion in patients with esophagorespiratory fistulas. Gastrointest Endosc 55:110–115

    Article  PubMed  Google Scholar 

  9. Kinsman KJ, DeGregorio BT, Katon RM et al (1996) Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. Gastrointest Endosc 43:196–203

    CAS  Article  PubMed  Google Scholar 

  10. Nishimura Y, Nagata K, Katano S et al (2003) Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents: a questionnaire survey of the Japanese Society for Esophageal Diseases. Int J Radiat Oncol Bio Phys 56:1327–1332

    Article  Google Scholar 

  11. Park JY, Shin JH, Song HY et al (2012) Airway complications after covered stent placement for malignant esophageal stricture: special reference to radiation therapy. AJR Am J Roentgenol 198:453–459

    Article  PubMed  Google Scholar 

  12. Meunier B, Spiliopoulos Y, Stasik C et al (1996) Retrosternal bypass operation for unresectable squamous cell cancer of the esophagus. Ann Thorac Surg 62:373–377

    CAS  Article  PubMed  Google Scholar 

  13. Meunier B, Stasik C, Raoul JL et al (1998) Gastric bypass for malignant esophagotracheal fistula: a series of 21 cases. Eur J Cardiothorac Surg 13:184–188

    CAS  Article  PubMed  Google Scholar 

  14. Hanagiri T, Morita M, Shigematsu Y et al (2011) Esophageal bypass using a gastric tube for a malignant tracheoesophageal/bronchoesophageal fistula: a report of 4 cases. Int Surg 96:189–193

    Article  PubMed  Google Scholar 

  15. Miyata T, Watanabe M, Nagai Y et al (2013) Successful esophageal bypass surgery in a patient with a large tracheoesophageal fistula following endotracheal stenting and chemoradiotherapy for advanced esophageal cancer: case report. Esophagus 10:27–29

    Article  PubMed  PubMed Central  Google Scholar 

  16. Burt M, Diehl W, Martini N et al (1991) Malignant esophagorespiratory fistula: management options and survival. Ann Thorac Surg 52:1222–1228

    CAS  Article  PubMed  Google Scholar 

  17. Postlethwait RW (1979) Technique for isoperistaltic gastric tube for esophageal bypass. Ann Surg 189:673–676

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Roeher HD, Horeyseck G (1981) The Kirschner bypass operation—a palliation for complicated esophageal carcinoma. World J Surg 5:543–546. doi:10.1007/BF01655007

    CAS  Article  PubMed  Google Scholar 

  19. Kawano T, Nishikage T, Kawada K et al (2009) Subcutaneous reconstruction using ileocolon with preserved ileocolic vessels following esophagectomy or in esophageal bypass operation. Dig Surg 26:200–204

    Article  PubMed  Google Scholar 

  20. Kawano T, Yoshino K, Endo M (1996) Cervical esophagogastric anastomosis by the cuff technique using a stapler. J Am Coll Surg 183:157–159

    CAS  PubMed  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  22. Duranceau A, Jamieson GG (1984) Malignant tracheoesophageal fistula. Ann Thorac Surg 37:346–354

    CAS  Article  PubMed  Google Scholar 

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Acknowledgments

This study was approved by the Human Ethics Review Committee of Tokyo Medical and Dental University (No. 2138).

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Affiliations

  1. Department of Esophageal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Yasuaki Nakajima, Kenro Kawada, Yutaka Tokairin, Yutaka Miyawaki, Takuya Okada & Tatsuyuki Kawano

  2. Department of Clinical Oncology, Tokyo Medical and Dental University, Tokyo, Japan

    Satoshi Miyake

Authors
  1. Yasuaki Nakajima
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  2. Kenro Kawada
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  3. Yutaka Tokairin
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  4. Yutaka Miyawaki
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  5. Takuya Okada
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  6. Satoshi Miyake
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  7. Tatsuyuki Kawano
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Correspondence to Yasuaki Nakajima.

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Nakajima, Y., Kawada, K., Tokairin, Y. et al. Retrospective Analyses of Esophageal Bypass Surgery for Patients with Esophagorespiratory Fistulas Caused by Esophageal Carcinomas. World J Surg 40, 1158–1164 (2016). https://doi.org/10.1007/s00268-015-3391-z

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  • DOI: https://doi.org/10.1007/s00268-015-3391-z

Keywords

  • Esophageal Carcinoma
  • Main Bronchus
  • Tracheal Stenosis
  • Abdominal Esophagus
  • Definitive Chemoradiotherapy