Tracheobronchial lesions following esophagectomy: erosions, ulcers, and fistulae, and the predictive value of lymph node-related factors.
BACKGROUND
Following esophagectomy, tracheobronchial lesions (TBLs) can occur as a result of ischemia caused by extensive dissection around the tracheobronchus. In this study we assessed the causes and clinical features of these complications, paying particular attention to lymph node (LN)-related factors.


METHODS
Between January 2000 and March 2007, 305 consecutive patients underwent subtotal esophagectomy using a transthoracic approach with LN dissection for thoracic esophageal cancer. TBLs, including erosions, ulcers, and fistulae, without traumatic injury during the operation, were detected during bronchoscopic examinations performed twice daily after the operation. The correlation between TBLs and tumor or surgical factors were analyzed.


RESULTS
TBLs were observed in 14 patients, accounting for an overall incidence of 5%; these included 6 fistulae, 5 ulcers, and 3 erosions. Cases with TBLs significantly more often involved three-field LN dissections (3FLD) than those without TBLs. Six (43%) patients with TBLs had more than four metastatic lymph nodes, while 9 (64%) had cervical and upper-mediastinal LN metastasis (p=0.034 and 0.041, respectively). More than 60 LNs were dissected from 10 (71%) patients with TBLs (p=0.021), and logistic regression analysis revealed that dissection of more than 60 lymph nodes and 3FLD were independent predictors of TBLs.


CONCLUSIONS
Esophageal cancer patients requiring extensive LN dissection of more than 60 nodes and/or 3FLD have an increased risk of developing a TBL during their postoperative course.
Maruyama
Kiyotomi
K
Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. kiyomaru@doc.med.akita-u.ac.jp
Motoyama
Satoru
S
Sato
Yusuke
Y
Hayashi
Kaori
K
Usami
Shuetu
S
Minamiya
Yoshihiro
Y
Ogawa
Jun-ichi
J
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D001980:Bronchi / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008477:Mediastinal Diseases / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology*; D016156:Respiratory Tract Fistula / Q000453:epidemiology; D014132:Trachea / Q000473:pathology*; D014133:Tracheal Diseases / Q000453:epidemiology; D014456:Ulcer / Q000453:epidemiology*