Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome.
BACKGROUND
Lesions of the trachea or main-stem bronchi with air leakage are a grave complication of oesophagectomy.


METHODS
Prevalence, predisposing factors and outcome of non-malignant lesions of the trachea or main-stem bronchi were analysed retrospectively in a consecutive series of 785 patients who had oesophagectomy for oesophageal cancer.


RESULTS
Overall 31 of 785 patients developed a tracheobronchial fistula 1-30 days after oesophagectomy. Based on the location of the lesions and clinical circumstances, the tracheobronchial fistulas were thought to be due to surgical injury (four patients), cuff pressure of the tracheostomy tube (two), local peritracheal infection resulting from a cervical anastomotic leak (seven) or 'ischaemia' after extensive peritracheal dissection (18). On multivariate analysis, transthoracic en bloc resection (P < 0.01) and preoperative radiochemotherapy for locally advanced tumours located at or above the level of the tracheal bifurcation (P < 0.01) predisposed to this complication.


CONCLUSIONS
Non-malignant tracheobronchial lesions are a serious complication of transthoracic oesophagectomy with extensive lymph node dissection, particularly in patients undergoing preoperative radiochemotherapy for locally advanced tumours.
Bartels
H E
HE
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technischen Universität München, Germany.
Stein
H J
HJ
Siewert
J R
JR
D000328:Adult; D000368:Aged; D000388:Air; D001982:Bronchial Diseases / Q000209:etiology*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014133:Tracheal Diseases / Q000209:etiology*; D014138:Tracheoesophageal Fistula / Q000209:etiology