Esophagopleural fistula: an early and long-term complication after pneumonectomy.
Over a 14-year period, we observed eight cases of esophagopleural fistula after pneumonectomy for cancer (n = 7) or infectious lung disease (n = 1). In 2 patients, the fistula was probably related to an intraoperative esophageal injury. Two others had mediastinal cancer recurrence, whereas a fistula developed in 4 without any malignancy. Patients presented with empyema, and a contrast swallow procedure disclosed an esophagopleural fistula. Two patients with recurrent cancer were managed conservatively with chest tube insertion and died within 3 months. A patient with chronic empyema had a delayed diagnosis of esophagopleural fistula 2 years after a presumed intraoperative injury; he was managed with thoracoplasty and feeding gastrostomy and died 12 months later. Five patients had an attempt at curative treatment. A single patient underwent thoracoplasty and bipolar exclusion of the esophagus and had secondary reconstruction with a coloplasty; he died with postoperative peritonitis. Four patients underwent thoracoplasty and muscle flap repair of the esophagus. There was 1 operative death from pulmonary embolism, whereas 3 patients recovered and are well with follow-up of 18 months, 2 years, and 5 years, respectively. We conclude that the prognosis of esophagopleural fistula is ominous when associated with cancer recurrence. A curative approach should combine direct repair of the esophagus with a muscle flap and eradication of the associated empyema with thoracoplasty. This aggressive treatment is addressed to debilitated patients and carries high rates of mortality and morbidity.
Department of Thoracic Surgery, University Hospital of Strasbourg, France.
G
G
Massard
X
X
Ducrocq
J G
JG
Hentz
R
R
Kessler
P
P
Dumont
J M
JM
Wihlm
G
G
Morand
D000368:Aged; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011013:Pneumonectomy / Q000009:adverse effects*; D011379:Prognosis; D011859:Radiography; D013997:Time Factors