- Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine, Chicago IL, 60611, USA;
Conduit failure and conduit airway fistula are rare complications after esophagectomy, however they can be catastrophic resulting in high mortality. Survivors can expect a prolonged hospital course with multiple interventions and an extended period of time prior to being able to resume oral nutrition. High index of suspicion can aid in early diagnosis. Conduit failure usually requires a period of proximal esophageal diversion and staged reconstruction. Conduit airway fistulas may be amenable to endoscopic repair but this has a high failure rate and many patients will require surgical repair with closure of the fistula and interposition of vascularized tissue to minimize recurrence.
Citation： ShariL. Meyerson, ChristopherK. Mehta. Managing Complications Ⅱ: Conduit Failure and Conduit Airway Fistulas. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(2): 113-118. doi: 10.7507/1007-4848.20160026 Copy
| 1. | Lerut T, Coosemans W, Decker G, et al. Anastomotic complications after esophagectomy. Dig Surg, 2002,19: 92-98. |
| 2. | Ferri LE, Law S, Wong KH, et al. The influence of technical comp-lications on postoperative outcome and survival after esophagectomy. Ann Surg Oncol, 2006, 13: 557-564. |
| 3. | Wormuth JK, Heitmiller RF. Esophageal conduit necrosis. Thorac Surg Clin, 2006, 16: 11-22. |
| 4. | Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg, 1995, 169: 634-640. |
| 5. | Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagec-tomy: clinical experience and refinements. Ann Surg, 1999, 230: 392-403. |
| 6. | Ramage L, Deguara J, Davies A, et al. Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue. Ann R Coll Surg Engl 2013;95:329-34. |
| 7. | Akiyama H. Esophageal anastomosis. Arch Surg, 1973, 107: 512-514. |
| 8. | Liebermann-Meffert DM, Meier R, Siewert JR. Vascular anatomy of the gastric tube used for esophageal reconstruction. Ann Thorac Surg, 1992, 54: 1110-1115. |
| 9. | Cassivi SD. Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg, 2004, 16: 124-132. |
| 10. | Dewar L, Gelfand G, Finley RJ, et al. Factors affecting cervical anastomotic leak and stricture formation following esophagogastrec-tomy and gastric tube interposition. Am J Surg, 1992, 163: 484-489. |
| 11. | Peracchia A, Bardini R, Ruol A, et al. Esophagovisceral anastomotic leak. A prospective statistical study of predisposing factors. J Thorac Cardiovasc Surg, 1988, 95: 685-691. |
| 12. | Sabel MS, Smith JL, Nava HR, et al. Esophageal resection for carcinoma in patients older than 70 years. Ann Surg Oncol, 2002, 9: 210-214. |
| 13. | Pierie JP, de Graaf PW, van Vroonhoven TJ, et al. The vasculariza-tion of a gastric tube as a substitute for the esophagus is affected by its diameter. Dis Esophagus, 1998, 11: 231-235. |
| 14. | Gupta NM, Gupta R. Transhiatal esophageal resection for corrosive injury. Ann Surg, 2004, 239: 359-363. |
| 15. | Perez M, Haumont T, Arnoux JM, et al. Anatomically based comparison of the different transthoracic routes for colon ascension after total esogastrectomy. Surg Radiol Anat, 2010, 32: 63-68. |
| 16. | Iannettoni MD, Whyte RI, Orringer MB. Catastrophic complica-tions of the cervical esophagogastric anastomosis. J Thorac Cardiovasc Surg, 1995, 110: 1493-1501. |
| 17. | Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg, 1997, 226: 169-173. |
| 18. | Heitmiller RF, Fischer A, Liddicoat JR. Cervical esophagogastric anastomosis: results following esophagectomy for carcinoma. Dis Esophagus, 1999, 12: 264-269. |
| 19. | Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119: 277-288. |
| 20. | Price TN, Nichols FC, Harmsen WS, et al. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg, 2013, 95: 1154-1161. |
| 21. | Davis PA, Law S, Wong J. Colonic interposition after esophagectomy for cancer. Arch Surg, 2003, 138: 303-308. |
| 22. | DeMeester TR, Johansson KE, Franze I, et al. Indications, surgical technique, and long-term functional results of colon interposition or bypass. Ann Surg, 1988, 208: 460-474. |
| 23. | Moorehead RJ, Wong J. Gangrene in esophageal substitutes after resection and bypass procedures for carcinoma of the esophagus. Hepatogastroenterology, 1990, 37: 364-367. |
| 24. | Dowson HM, Strauss D, Ng R, et al. The acute management and surgical reconstruction following failed esophagectomy in malignant disease of the esophagus. Dis Esophagus, 2007, 20: 135-140. |
| 25. | Page RD, Asmat A, McShane J, et al. Routine endoscopy to detect anastomotic leakage after esophagectomy. Ann Thorac Surg, 2013, 95: 292-298. |
| 26. | Oezcelik A, Banki F, Ayazi S, et al. Detection of gastric conduit ischemia or anastomotic breakdown after cervical esophagogastro-stomy: the use of computed tomography scan versus early endoscopy. Surg Endosc, 2010, 24: 1948-1951. |
| 27. | Paul S, Bueno R. Section VI: complications following esophagectomy: early detection, treatment, and prevention. Semin Thorac Cardio-vasc Surg, 2003, 15: 210-215. |
| 28. | Heitmiller RF, Gruber PJ, Swier P, et al. Long-segment substernal jejunal esophageal replacement with internal mammary vascular augmentation. Dis Esophagus, 2000, 13: 240-242. |
| 29. | Schuchert MJ, Abbas G, Nason KS, et al. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery, 2010,148: 831-840. |
| 30. | Buskens CJ, Hulscher JB, Fockens P, et al. Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy. Ann Thorac Surg, 2001, 72: 221-224. |
| 31. | Bakhos C, Alazemi S, Michaud G, et al. Staged repair of benign tracheo-neo-esophageal fistula 12 years after esophagectomy for esophageal cancer. Ann Thorac Surg, 2010, 90: e83-e85. |
| 32. | Kron IL, Johnson AM, Morgan RF. Gastrotracheal fistula: a late complication after transhiatal esophagectomy. Ann Thorac Surg, 1989, 47: 767-768. |
| 33. | Saito H, Minamiya Y, Hashimoto M, et al. Repair of reconstructed gastric tube bronchial fistulas after operation for esophageal cancer by transposing a pedicled pectoralis major muscle flap: report of three successful cases. Surgery, 1998, 123: 365-368. |
| 34. | Hayashi K, Ando N, Ozawa S, et al. Gastric tube-to-tracheal fistula closed with a latissimus dorsi myocutaneous flap. Ann Thorac Surg, 1999, 68: 561-562. |
| 35. | Bartels HE, Stein HJ, Siewert JR. Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome. Br J Surg, 1998, 85: 403-406. |
| 36. | Fujita H, Kawahara H, Hidaka M, et al. An experimental study on viability of the devascularized trachea. Jpn J Surg, 1988, 18: 77-83. |
| 37. | 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, 2009, 33: 778-784. |
| 38. | Kalmár K, Molnár TF, Morgan A, et al. Non-malignant tracheo-gastric fistula following esophagectomy for cancer. Eur J Cardio-thorac Surg, 2000,18: 363-365. |
| 39. | Nordin U. The trachea and cuff-induced tracheal injury. An experi-mental study on causative factors and prevention. Acta Otolaryngol Suppl, 1977, 345: 1-71. |
| 40. | Shichinohe T, Okushiba S, Morikawa T, et al. Salvage of a massive esophago-tracheal fistula resulting from a stenting treatment. Dis Esophagus, 2006, 19: 299-304. |
| 41. | Truong S, Böhm G, Klinge U, et al. Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue. Surg Endosc, 2004, 18: 1105-1108. |
| 42. | Ng WT, Luk HT, Lau CW. Endoscopic treatment of recurrent tracheo-oesophageal fistulae: the optimal technique. Pediatr Surg Int, 1999, 15: 449-450. |
| 43. | Marone G, Santoro LM, Torre V. Successful endoscopic treatment of GI-tract fistulas with a fast-hardening amino acid solution. Endoscopy, 1989, 21: 47-49. |
| 44. | Nardella JE, Van Raemdonck D, Piessevaux H, et al. Gastro-tracheal fistula--unusual and life threatening complication after esophagec-tomy for cancer: a case report. J Cardiothorac Surg, 2009, 4: 69. |
| 45. | Boyd M, Rubio E. The utility of stenting in the treatment of airway gastric fistula after esophagectomy for esophageal cancer. J Bronchology Interv Pulmonol, 2012, 19: 232-236. |
| 46. | Elbe P, Lindblad M, Tsai J, et al. Non-malignant respiratory tract fistula from the oesophagus. A lethal condition for which novel therapeutic options are emerging. Interact Cardiovasc Thorac Surg, 2013, 16: 257-262. |
| 47. | Repici A, Presbitero P, Carlino A, et al. First human case of esopha-gus-tracheal fistula closure by using a cardiac septal occluder (with video). Gastrointest Endosc, 2010, 71: 867-869. |
| 48. | Reames BN, Lin J. Repair of a complex bronchogastric fistula after esophagectomy with biologic mesh. Ann Thorac Surg, 2013, 95: 1096-1097. |
- 1. Lerut T, Coosemans W, Decker G, et al. Anastomotic complications after esophagectomy. Dig Surg, 2002,19: 92-98.
- 2. Ferri LE, Law S, Wong KH, et al. The influence of technical comp-lications on postoperative outcome and survival after esophagectomy. Ann Surg Oncol, 2006, 13: 557-564.
- 3. Wormuth JK, Heitmiller RF. Esophageal conduit necrosis. Thorac Surg Clin, 2006, 16: 11-22.
- 4. Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg, 1995, 169: 634-640.
- 5. Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagec-tomy: clinical experience and refinements. Ann Surg, 1999, 230: 392-403.
- 6. Ramage L, Deguara J, Davies A, et al. Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue. Ann R Coll Surg Engl 2013;95:329-34.
- 7. Akiyama H. Esophageal anastomosis. Arch Surg, 1973, 107: 512-514.
- 8. Liebermann-Meffert DM, Meier R, Siewert JR. Vascular anatomy of the gastric tube used for esophageal reconstruction. Ann Thorac Surg, 1992, 54: 1110-1115.
- 9. Cassivi SD. Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg, 2004, 16: 124-132.
- 10. Dewar L, Gelfand G, Finley RJ, et al. Factors affecting cervical anastomotic leak and stricture formation following esophagogastrec-tomy and gastric tube interposition. Am J Surg, 1992, 163: 484-489.
- 11. Peracchia A, Bardini R, Ruol A, et al. Esophagovisceral anastomotic leak. A prospective statistical study of predisposing factors. J Thorac Cardiovasc Surg, 1988, 95: 685-691.
- 12. Sabel MS, Smith JL, Nava HR, et al. Esophageal resection for carcinoma in patients older than 70 years. Ann Surg Oncol, 2002, 9: 210-214.
- 13. Pierie JP, de Graaf PW, van Vroonhoven TJ, et al. The vasculariza-tion of a gastric tube as a substitute for the esophagus is affected by its diameter. Dis Esophagus, 1998, 11: 231-235.
- 14. Gupta NM, Gupta R. Transhiatal esophageal resection for corrosive injury. Ann Surg, 2004, 239: 359-363.
- 15. Perez M, Haumont T, Arnoux JM, et al. Anatomically based comparison of the different transthoracic routes for colon ascension after total esogastrectomy. Surg Radiol Anat, 2010, 32: 63-68.
- 16. Iannettoni MD, Whyte RI, Orringer MB. Catastrophic complica-tions of the cervical esophagogastric anastomosis. J Thorac Cardiovasc Surg, 1995, 110: 1493-1501.
- 17. Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg, 1997, 226: 169-173.
- 18. Heitmiller RF, Fischer A, Liddicoat JR. Cervical esophagogastric anastomosis: results following esophagectomy for carcinoma. Dis Esophagus, 1999, 12: 264-269.
- 19. Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119: 277-288.
- 20. Price TN, Nichols FC, Harmsen WS, et al. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg, 2013, 95: 1154-1161.
- 21. Davis PA, Law S, Wong J. Colonic interposition after esophagectomy for cancer. Arch Surg, 2003, 138: 303-308.
- 22. DeMeester TR, Johansson KE, Franze I, et al. Indications, surgical technique, and long-term functional results of colon interposition or bypass. Ann Surg, 1988, 208: 460-474.
- 23. Moorehead RJ, Wong J. Gangrene in esophageal substitutes after resection and bypass procedures for carcinoma of the esophagus. Hepatogastroenterology, 1990, 37: 364-367.
- 24. Dowson HM, Strauss D, Ng R, et al. The acute management and surgical reconstruction following failed esophagectomy in malignant disease of the esophagus. Dis Esophagus, 2007, 20: 135-140.
- 25. Page RD, Asmat A, McShane J, et al. Routine endoscopy to detect anastomotic leakage after esophagectomy. Ann Thorac Surg, 2013, 95: 292-298.
- 26. Oezcelik A, Banki F, Ayazi S, et al. Detection of gastric conduit ischemia or anastomotic breakdown after cervical esophagogastro-stomy: the use of computed tomography scan versus early endoscopy. Surg Endosc, 2010, 24: 1948-1951.
- 27. Paul S, Bueno R. Section VI: complications following esophagectomy: early detection, treatment, and prevention. Semin Thorac Cardio-vasc Surg, 2003, 15: 210-215.
- 28. Heitmiller RF, Gruber PJ, Swier P, et al. Long-segment substernal jejunal esophageal replacement with internal mammary vascular augmentation. Dis Esophagus, 2000, 13: 240-242.
- 29. Schuchert MJ, Abbas G, Nason KS, et al. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery, 2010,148: 831-840.
- 30. Buskens CJ, Hulscher JB, Fockens P, et al. Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy. Ann Thorac Surg, 2001, 72: 221-224.
- 31. Bakhos C, Alazemi S, Michaud G, et al. Staged repair of benign tracheo-neo-esophageal fistula 12 years after esophagectomy for esophageal cancer. Ann Thorac Surg, 2010, 90: e83-e85.
- 32. Kron IL, Johnson AM, Morgan RF. Gastrotracheal fistula: a late complication after transhiatal esophagectomy. Ann Thorac Surg, 1989, 47: 767-768.
- 33. Saito H, Minamiya Y, Hashimoto M, et al. Repair of reconstructed gastric tube bronchial fistulas after operation for esophageal cancer by transposing a pedicled pectoralis major muscle flap: report of three successful cases. Surgery, 1998, 123: 365-368.
- 34. Hayashi K, Ando N, Ozawa S, et al. Gastric tube-to-tracheal fistula closed with a latissimus dorsi myocutaneous flap. Ann Thorac Surg, 1999, 68: 561-562.
- 35. Bartels HE, Stein HJ, Siewert JR. Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome. Br J Surg, 1998, 85: 403-406.
- 36. Fujita H, Kawahara H, Hidaka M, et al. An experimental study on viability of the devascularized trachea. Jpn J Surg, 1988, 18: 77-83.
- 37. 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, 2009, 33: 778-784.
- 38. Kalmár K, Molnár TF, Morgan A, et al. Non-malignant tracheo-gastric fistula following esophagectomy for cancer. Eur J Cardio-thorac Surg, 2000,18: 363-365.
- 39. Nordin U. The trachea and cuff-induced tracheal injury. An experi-mental study on causative factors and prevention. Acta Otolaryngol Suppl, 1977, 345: 1-71.
- 40. Shichinohe T, Okushiba S, Morikawa T, et al. Salvage of a massive esophago-tracheal fistula resulting from a stenting treatment. Dis Esophagus, 2006, 19: 299-304.
- 41. Truong S, Böhm G, Klinge U, et al. Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue. Surg Endosc, 2004, 18: 1105-1108.
- 42. Ng WT, Luk HT, Lau CW. Endoscopic treatment of recurrent tracheo-oesophageal fistulae: the optimal technique. Pediatr Surg Int, 1999, 15: 449-450.
- 43. Marone G, Santoro LM, Torre V. Successful endoscopic treatment of GI-tract fistulas with a fast-hardening amino acid solution. Endoscopy, 1989, 21: 47-49.
- 44. Nardella JE, Van Raemdonck D, Piessevaux H, et al. Gastro-tracheal fistula--unusual and life threatening complication after esophagec-tomy for cancer: a case report. J Cardiothorac Surg, 2009, 4: 69.
- 45. Boyd M, Rubio E. The utility of stenting in the treatment of airway gastric fistula after esophagectomy for esophageal cancer. J Bronchology Interv Pulmonol, 2012, 19: 232-236.
- 46. Elbe P, Lindblad M, Tsai J, et al. Non-malignant respiratory tract fistula from the oesophagus. A lethal condition for which novel therapeutic options are emerging. Interact Cardiovasc Thorac Surg, 2013, 16: 257-262.
- 47. Repici A, Presbitero P, Carlino A, et al. First human case of esopha-gus-tracheal fistula closure by using a cardiac septal occluder (with video). Gastrointest Endosc, 2010, 71: 867-869.
- 48. Reames BN, Lin J. Repair of a complex bronchogastric fistula after esophagectomy with biologic mesh. Ann Thorac Surg, 2013, 95: 1096-1097.