title: Tracheobronchial injury in the setting of an esophagectomy for cancer: postoperative discovery a bad omen.
abstract: BACKGROUND
  A tracheobronchial injury is an uncommon complication of an esophagectomy. Differences in outcomes may exist for patients with injuries detected intraoperatively and postoperatively.
  
  
  METHODS
  A retrospective review was performed for patients who underwent an esophagectomy for cancer at Jackson Memorial Hospital/University of Miami from January 2000 to June 2012.
  
  
  RESULTS
  An injury to the tracheobronchial tree occurred in 7 of 425 patients (1.6%). The majority of the operations were performed via a transhiatal approach (87.8%). Patients with airway injuries were older (median 73 vs. 63), more likely to have squamous cell carcinoma (85.7% vs. 17.9%), and with proximal tumors (85.7% vs. 14.1%). When given, the type of neoadjuvant treatment consisted of chemoradiotherapy in all patients who suffered an injury, whereas it was only administered to 21.3% of patients without an injury. There were no deaths among three patients in whom the injury was identified intraoperatively. Mortality occurred in three of four patients (75.0%) with an injury detected postoperatively.
  
  
  CONCLUSIONS
  Patients with proximal tumors and radiation administration as a component of neoadjuvant treatment are more likely to suffer a tracheobronchial injury. An aggressive reoperative approach is warranted in patients with injuries that are discovered postoperatively.
authors.affiliation: Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
authors.forename: Vadim P
authors.initials: VP
authors.lastname: Koshenkov
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: Dido
authors.initials: D
authors.lastname: Franceschi
mesh_terms: D000328:Adult; D000368:Aged; D001980:Bronchi / Q000293:injuries* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014132:Trachea / Q000293:injuries* / Q000601:surgery; D014947:Wounds and Injuries / Q000209:etiology*
keywords: major airway; malignancy; radiation; transhiatal