Treatment strategy for benign gastric tube-tracheobronchial fistula after esophagectomy for esophageal cancer: 9 case reports and review of the literature

Benign gastric tube-tracheobronchial fistula after esophagectomy for esophageal cancer is a rare life-threatening complication observed after gastric tube reconstruction via the posterior mediastinal route. However, the literature for this complication is limited, comprising only a few case reports; therefore, its treatment strategy remains unclear. Here, we have summarized such cases that were managed at our institution and have reviewed previous literature in order to design a relevant treatment strategy for this complication. We have included nine cases of benign gastric tube-tracheobronchial fistula after esophagectomy for esophageal cancer that were encountered during 1993-2011, with their clinical features, treatment methods, and outcomes. In addition, 37 reports published during 1990-2012 from the PubMed database comprising 61 such cases have been reviewed. A total of 70 patients (published cases and our cases) were analyzed with regard to pathogenesis, treatment methods, and outcomes. The fistula type was found to determine the fistula site. Surgical treatment had the highest recovery rate of any of the types of benign gastric tube-tracheobronchial fistula after esophagectomy for esophageal cancer; further, approximately 30 % of the patients who initially received conservative or endoscopic treatment required conversion to operative treatment. Cases wherein leakage occurred were more frequently managed by conservative and endoscopic treatments than other types of such fistulas, with a good recovery rate. We conclude that the primary treatment for benign gastric tube-tracheobronchial fistula after esophagectomy for esophageal cancer is surgery based on the fistula type and site.