title: Therapeutic strategy for treating aortoesophageal fistulas.
abstract: OBJECTIVE
  The development fistulas between the thoracic aorta and the esophagus are highly fatal conditions. We aimed to identify a therapeutic strategy for treating aortoesophageal fistula (AEF) in this study, by investigating all AEF cases presented in this special symposium at the 65th Annual Scientific Meeting of the Japanese Association for Thoracic Surgery.
  
  
  METHODS
  Forty-seven AEF patients were included in this study. The survivors and nonsurvivors at six and 18 months after diagnosis of AEF were classified into "Group A6", "Group D6", "Group A18", and "Group D18", respectively. Comparisons between Group A6 and Group D6 and between Group A18 and Group D18 were made with regard to therapeutic strategy.
  
  
  RESULTS
  Twenty-two (46.8 %) and 33 (70.3 %) of the 47 patients died within 6 and 18 months, respectively. The patients treated with omentum wrapping (p = 0.0052), esophagectomy (p = 0.0269) and a graft replacement strategy for the aorta (p = 0.002) were more frequently included in Group A6. The patients with the omentum wrapping (p = 0.0174) and esophagectomy (p = 0.0203) and graft replacement were more significantly included in Group A18. The results of the multivariate analysis indicated that the mortality rate at 6 and 18 months after diagnosis was significantly correlated with graft replacement (p = 0.0188) and esophagectomy (p = 0.0257), respectively. There were significant differences in the actuarial survival curves in patients who had omentum wrapping, graft replacement, and esophagectomy compared to patients who did not have these 3 therapeutic procedures.
  
  
  CONCLUSIONS
  The use of thoracic endovascular aortic repair alone for AEF should not be considered a definitive surgery. In contrast, esophagectomy, open surgery with aortic replacement using prostheses and homografts and greater omentum wrapping significantly improve the mid-term survival of AEF.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830, Japan, akashi@med.kurume-u.ac.jp.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Akashi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kawamoto
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Saiki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
authors.forename: Takuro
authors.initials: T
authors.lastname: Tsukube
authors.forename: Suguru
authors.initials: S
authors.lastname: Kubota
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
authors.forename: Norihisa
authors.initials: N
authors.lastname: Karube
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Imoto
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kondo
authors.forename: Satoru
authors.initials: S
authors.lastname: Tobinaga
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Fujita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D003430:Cross-Sectional Studies; D057510:Endovascular Procedures / Q000379:methods / Q000401:mortality; D004937:Esophageal Fistula / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous / Q000379:methods / Q000401:mortality; D016157:Vascular Fistula / Q000401:mortality / Q000601:surgery*