TRACHEOBRONCHIAL LESIONS FOLLOWING ESOPHAGECTOMY - PREVALENCE, PREDISPOSING FACTORS AND OUTCOME

Background Lesions of the trachea or main-stem bronchi with air leakag e are a grave complication of oesophagectomy. Methods Prevalence, pred isposing factors and outcome of non-malignant lesions of the trachea o r main-stem bronchi were analysed retrospectively in a consecutive ser ies of 785 patients who had oesophagectomy for oesophageal cancer. Res ults Overall 31 of 785 patients developed a tracheobronchial fistula 1 -30 days after oesophagectomy. Based on the location of the lesions an d clinical circumstances, the tracheobronchial fistulas were thought t o be due to surgical injury (four patients), cuff pressure of the trac heostomy tube (two), local peritracheal infection resulting from a cer vical anastomotic leak (seven) or 'ischaemia' after extensive peritrac heal dissection (18). On multivariate analysis, transthoracic en bloc resection (P < 0.01) and preoperative radiochemotherapy for locally ad vanced tumours located at or above the level of the tracheal bifurcati on (P < 0.01) predisposed to this complication. Conclusion Non-maligna nt tracheobronchial lesions are a serious complication of transthoraci c oesophagectomy with extensive lymph node dissection, particularly in patients undergoing preoperative radiochemotherapy for locally advanc ed tumours.