title: Successful esophageal bypass surgery in a patient with a large tracheoesophageal fistula following endotracheal stenting and chemoradiotherapy for advanced esophageal cancer: case report.
abstract: A 63-year-old man with esophageal achalasia for more than 20 years complained of respiratory distress. He was admitted as an emergency to the referral hospital three months previously. Computed tomography revealed tracheobronchial stenosis due to advanced esophageal cancer with tracheal invasion. He underwent tracheobronchial stenting and chemoradiotherapy. A large tracheoesophageal fistula (TEF) developed after irradiation (18 Gy) and chemotherapy, and he was unable to eat. Thereafter, he was referred to our hospital, where we performed esophageal bypass surgery using a gastric conduit. A percutaneous cardiopulmonary support system was prepared due to the risk of airway obstruction during anesthesia. A small-diameter tracheal tube inserted into the stent achieved ordinary respiratory management. No anesthesia-related problems were encountered. Oral intake commenced on postoperative day 9. He was discharged on postoperative day 23 and was able to take in sustenance orally right up to the last moment of his life. Esophageal bypass under general anesthesia can be performed in patients with large TEF with sufficient preparation for anesthetic management.
authors.affiliation: Department of Gastrointestinal Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Kumamoto, 860-8556 Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Miyata
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yohei
authors.initials: Y
authors.lastname: Nagai
authors.forename: Masaaki
authors.initials: M
authors.lastname: Iwatsuki
authors.forename: Shiro
authors.initials: S
authors.lastname: Iwagami
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Baba
authors.forename: Chiyo
authors.initials: C
authors.lastname: Furushou
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ikuta
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
keywords: Esophageal bypass; Tracheobronchial stent; Tracheoesophageal fistula