ESOPHAGOPLEURAL FISTULA - AN EARLY AND LONG-TERM COMPLICATION AFTER PNEUMONECTOMY

Over a 14-year period, we observed eight cases of esophagopleural fist ula after pneumonectomy for cancer (n = 7) or infectious lung disease (n = 1). In 2 patients, the fistula was probably related to an intraop erative esophageal injury. Two others had mediastinal cancer recurrenc e, whereas a fistula developed in 4 without any malignancy. Patients p resented with empyema, and a contrast swallow procedure disclosed an e sophagopleural fistula. Two patients with recurrent cancer were manage d conservatively with chest tube insertion and died within 3 months. A patient with chronic empyema had a delayed diagnosis of esophagopleur al fistula 2 years after a presumed intraoperative injury; he was mana ged with thoracoplasty and feeding gastrostomy and died 12 months late r. Five patients had an attempt at curative treatment. A single patien t underwent thoracoplasty and bipolar exclusion of the esophagus and h ad secondary reconstruction with a coloplasty; he died with postoperat ive peritonitis. Four patients underwent thoracoplasty and muscle nap repair of the esophagus. There was 1 operative death from pulmonary em bolism, whereas 3 patients recovered and are well with follow-up of 18 months, 2 years, and 5 years, respectively. We conclude that the prog nosis of esophagopleural fistula is ominous when associated with cance r recurrence. A curative approach should combine direct repair of the esophagus with a muscle nap and eradication of the associated empyema with thoracoplasty. This aggressive treatment is addressed to debilita ted patients and carries high rates of mortality and morbidity.