title: Surgical repair of esophagobronchial fistula caused by radiation injury.
abstract: We present an unusual case of a benign esophagobronchial fistula caused by radiotherapy to treat esophageal carcinoma which was closed successfully. A 62-year-old man with superficial squamous cell carcinoma of the esophagus underwent radiotherapy, including 60 Gy externally and 10 Gy intraluminally from January to March 1995. Esophagography revealed a fistula between the esophagus and left main stem bronchus on January 14, 1996. No residual cancer existed. Neither stenting with a silicone tube nor with a covered flexible metallic stent occluded the fistula. Thoracic esophagectomy, closure of the esophagobronchial fistula using a 2-cm nubbin of esophageal wall, surrounding the orifice of the fistula and antesternal gastric pull-through reconstruction with mediastinal lymphadenectomy were performed. The postoperative course was uneventful and there is no evidence of recurrence of the fistula or the cancer 5 years postoperatively. Radiotherapy may cause esophagobronchial fistula even in cases of superficial esophageal cancer. Bypass surgery should be considered because stenting is not effective for benign fistula without stricture.
authors.affiliation: Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. fuku@eva.hi-ho.ne.jp
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Fukuhara
authors.forename: Harushi
authors.initials: H
authors.lastname: Osugi
authors.forename: Taigo
authors.initials: T
authors.lastname: Tokuhara
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Takada
authors.forename: Masashi
authors.initials: M
authors.lastname: Takemura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Lee
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Ueno
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yushi
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishizawa
authors.forename: Yukie
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects