Injury to the major airways during subtotal esophagectomy: Incidence, management, and sequelae

Objective: The objective of this study was to gain insight into the inciden ce and sequelae of injury to the major airways during subtotal esophagectom y. Methods: We performed an analysis of 383 consecutive patients undergoing th is procedure between 1993 and 1999. Indications were adenocarcinoma (220), squamous cell carcinoma (121), and other (42). Transhiatal resection was do ne in 269 (70%) patients and transthoracic resection in 114 (30%). Results: There were 4 men and 2 women (median age 57 years; range 45 to 68 years) with injury to the major airways, recognized during surgery in 5 pat ients and on the first postoperative day in the other. Five lesions occurre d during transhiatal resection (5 of 269 = 1.8%) and 1 during transthoracic resection (1 of 114 = 0.8%; P =.67). The injury occurred proximal to the c arina in 5 patients and in the left main bronchus in the other. All injurie s could be closed primarily. The defect was covered with pericardium in 1 p atient and with pleura in 2 patients. In all cases the gastric tube was pla ced over the defect. Pulmonary complications developed in 4 patients. Patie nts with tracheal injury required artificial ventilation for a longer perio d (median 6 days vs 1 day; P =.02) and stayed longer in the intensive care unit (median 11 vs 3 days; P <.01) than patients without such injury, altho ugh hospital time was not significantly prolonged (median 23 vs 16 days; P =.09). There was no associated mortality. Conclusion: Tracheobronchial injury is a rare complication of subtotal esop hagectomy. It can be managed effectively by primary closure and apposition of vital tissue (gastric tube) to the defect. It is associated with pulmona ry complications, leading to prolonged assisted ventilation and stay in the intensive care unit, but mortality is rare.