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Treatment of aortoesophageal fistula developed after thoracic endovascular aortic repair: a questionnaire survey study

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Abstract

Background

Aortoesophageal fistula (AEF) is a life-threatening late complication that can occur after thoracic endovascular aortic repair (TEVAR). More data are required to identify the optimal treatment strategy for AEF developed after TEVAR. The aim of this study was to clarify the current status of surgical treatments for AEF developed after TEVAR and the outcomes of these treatments.

Methods

The Japan Esophageal Society conducted a questionnaire survey targeting authorized or semi-authorized institutes at Authorized Institutes for Board Certified Esophageal Surgeons. Thirty-nine patients with AEF developed after TEVAR were identified from 15 institutes. Data on patient demographics, treatment performed, and survival rate were obtained by the questionnaire. The Kaplan–Meier method was used for survival analysis and differences in the survival rates.

Results

Esophagectomy and aortic replacement were performed in 32 and 22 patients, respectively, and 22 underwent both procedures. Postoperative complications were observed in 24 patients (75.0%). Complications with Clavien–Dindo Grade III or higher were observed in 53.1% of patients. Operative and hospital mortality rates were 3.1% and 18.8%, respectively. The survival rate in patients who underwent esophagectomy was higher than in those who did not (P < 0.0001). The survival of patients who underwent both esophagectomy and aortic replacement was also higher than in those who did not (P < 0.0001).

Conclusion

Esophagectomy combined with aortic replacement can offer a long-term treatment strategy with higher survival rates in patients who develop AEF after TEVAR. Because of the high incidence of postoperative morbidity and mortality, these types of surgery should only be performed in centers with both experienced esophageal and cardiovascular surgical teams.

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Acknowledgements

The authors wish to thank all participating centers, specifically those who provided patient data: Masaki Ohi (Mie University, Mie); Yoshihiro Ohta (Tokyo Medical University, Tokyo); Yoshihiro Kakeji (Kobe University, Hyogo); Hiroyuki Kitagawa (Kochi University, Kochi); Koji Kono (Fukushima Medical University, Fukushima); Toshiaki Shichinohe (Hokkaido University, Hokkaido); Shinsuke Takeno (Miyazaki University, Miyazaki); Akira Tangoku (Tokushima University, Tokushima); Masanobu Nakajima (Dokkyo Medical University, Tochigi); Kousuke Narumiya (Tokyo Women’s Medical University, Tokyo); Hideo Baba (Kumamoto University, Kumamoto); Yoichi Hamai (Hiroshima University, Hiroshima); Hitoshi Fujiwara (Kyoto Prefectural University of Medicine, Kyoto); Hisahiro Matsubara (Chiba University, Chiba); and Satoru Motoyama (Akita University, Akita).

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Authors and Affiliations

  1. The Japan Esophageal Society, 2-3-13 Taihei, Sumida-ku, Tokyo, 103-0012, Japan

    Masayuki Watanabe, Michio Sato, Minoru Fukuchi, Hiroyuki Kato & Hisahiro Matsubara

  2. Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Masayuki Watanabe

  3. Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan

    Michio Sato

  4. Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Koun-cho, Maebashi, Gunma, 371-0025, Japan

    Minoru Fukuchi

  5. Department of Surgery, Kiryu Kosei Hospital, 16-3 Orihime-machi, Kiryu, Gunma, 376-0024, Japan

    Hiroyuki Kato

  6. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan

    Hisahiro Matsubara

Authors
  1. Masayuki Watanabe
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  2. Michio Sato
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  3. Minoru Fukuchi
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  4. Hiroyuki Kato
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  5. Hisahiro Matsubara
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Corresponding author

Correspondence to Masayuki Watanabe.

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Ethical Statement

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and comply with the Helsinki Declaration of 1964 and all subsequent versions.

Conflict of interest

Watanabe M, Sato M, Fukuchi M, Kato H, and Matsubara H declare that they have no conflicts of interest.

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Watanabe, M., Sato, M., Fukuchi, M. et al. Treatment of aortoesophageal fistula developed after thoracic endovascular aortic repair: a questionnaire survey study. Esophagus 17, 81–86 (2020). https://doi.org/10.1007/s10388-019-00683-y

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  • DOI: https://doi.org/10.1007/s10388-019-00683-y

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