Airway Necrosis after Salvage Esophagectomy

Norimitsu Tanaka, Nobukazu Hokamura and Yuji Tachimori

Esophageal Surgery Division, National Cancer Center Hospital

Introduction: Salvage esophagectomy is the sole curative intent treatment for patients with persistent or recurrent locoregional disease after definitive chemoradiotherapy (CRT) for esophageal carcinoma. However, salvage esophagectomy is a very high-risk operation, and airway necrosis is a fatal complication. Methods: Between 1997 and 2007, 49 patients with thoracic esophageal cancer underwent salvage esophagectomy after definitive CRT. We retrospectively compared patients with and without airway necrosis, and investigated operative procedures related to airway necrosis. Result: Airway necrosis occurred in five patients (10.2%), of four patients (80%) died during their hospitalization. Airway necrosis seemed to be closely related to operative procedures, such as resection of bronchial artery and cervical and subcarinal lymph node dissection. Bronchogastric fistula following necrosis of gastric conduit occured in 2 patients reconstructed through posterior mediastinal route. Conclusions: Airway necrosis is a highly lethal complication after salvage esophagectomy. It is important in salvage esophagectomy to take airway blood supply into consideration sufficiently and to reconstruct through retrosternal route to prevent bronchogastric fistula.

Key words
salvage esophagectomy, airway necrosis, chemoradiotherapy, esophageal cancer

Reprint requests
Norimitsu Tanaka Department of Cancer and Thoracic Surgery, Graduate School of Medicine and Dentistry, Okayama University
2-5-1 Shikata-cho, Okayama, 700-8558 JAPAN

Accepted
January 27, 2010

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