PS02.173: SURGICAL MANAGEMENT OF TRACHEOESOPHAGEAL FISTULAS IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Background Tracheoesophageal fistula is a severe complication that can occur in patients who are treated for esophageal cancer. There is currently no consensus about the best surgical treatment. The aim of this study was to evaluate the results after surgical treatment of tracheoesophageal fistulas in patients with a history of esophageal cancer in a tertiary referral center. Methods Consecutive patients with a history of esophageal cancer who were surgically treated for tracheoesophageal fistulas between January 2010 and December 2017 were included. Primary outcome was success rate after surgical treatment. Surgical treatment was defined as successful if no combined (30-day or in-hospital) mortality and no recurrences occurred. Results Twenty patients underwent 26 surgical treatments for tracheoesophageal fistulas. Median age was 64 years (IQR 59–68). One patient developed a tracheoesophageal fistula elsewhere and was referred to our center. The incidence of tracheoesophageal fistulas following esophagectomy in our center was 1.9% (n = 13). Other tracheoesophageal fistulas were caused by traumatic intubation (n = 3) or definitive chemoradiation (n = 3). Surgery consisted of covering the tracheal defect with a muscle flap (n = 15), and/or pericardial patch (n = 11) or primary sutures (n = 5) possibly with resection of the reconstruction (n = 6). The median follow-up was 7.8 months (IQR 1.5–38.2). Treatment was successful in 60.0% of the patients (n = 12). Overall morbidity and combined (in-hospital and 30-day) mortality rates were 65.0% and 35.0%, respectively. In the last 5 patients the muscle flap was fixated to the tracheal defect and reinforced by bovine or autogenic pericardium in whom there was no mortality. Recurrences occurred in 7 patients (35.0%), but only 5 were physically eligible for secondary surgical treatment. The other patients died due to the recurrence. Patients with infectious cause of their tracheoesophageal fistula (n = 11) had more complications (7 versus 6 patients), higher mortality (5 versus 2 patients) and more recurrences (5 versus 2) than non-infectious tracheoesophageal fistulas. Conclusion Tracheoesophageal fistula is a severe complication and is associated with high mortality and recurrence rates. Surgical treatment should only be performed in tertiary referral centers. Using muscle flaps with reinforcement of pericardium might reduce the morbidity and mortality, but larger patient groups should be investigated. Disclosure All authors have declared no conflicts of interest.