Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
J Surg Oncol. 2014 Jun;109(8):804-7. doi: 10.1002/jso.23577. Epub 2014 Feb 17.
A tracheobronchial injury is an uncommon complication of an esophagectomy. Differences in outcomes may exist for patients with injuries detected intraoperatively and postoperatively.
A retrospective review was performed for patients who underwent an esophagectomy for cancer at Jackson Memorial Hospital/University of Miami from January 2000 to June 2012.
An injury to the tracheobronchial tree occurred in 7 of 425 patients (1.6%). The majority of the operations were performed via a transhiatal approach (87.8%). Patients with airway injuries were older (median 73 vs. 63), more likely to have squamous cell carcinoma (85.7% vs. 17.9%), and with proximal tumors (85.7% vs. 14.1%). When given, the type of neoadjuvant treatment consisted of chemoradiotherapy in all patients who suffered an injury, whereas it was only administered to 21.3% of patients without an injury. There were no deaths among three patients in whom the injury was identified intraoperatively. Mortality occurred in three of four patients (75.0%) with an injury detected postoperatively.
Patients with proximal tumors and radiation administration as a component of neoadjuvant treatment are more likely to suffer a tracheobronchial injury. An aggressive reoperative approach is warranted in patients with injuries that are discovered postoperatively.
气管支气管损伤是食管癌切除术的一种罕见并发症。对于术中及术后发现的损伤患者，其结局可能存在差异。
对 2000 年 1 月至 2012 年 6 月期间在杰克逊纪念医院/迈阿密大学接受食管癌切除术的患者进行了回顾性研究。
425 例患者中发生气管支气管树损伤 7 例（1.6%）。大多数手术采用经食管裂孔入路（87.8%）。气道损伤患者年龄更大（中位数 73 岁比 63 岁），更可能患有鳞状细胞癌（85.7%比 17.9%），且肿瘤位于近端（85.7%比 14.1%）。发生损伤的患者均接受新辅助放化疗，而未发生损伤的患者仅 21.3%接受了该治疗。术中发现损伤的 3 例患者中无死亡病例。术后发现损伤的 4 例患者中有 3 例死亡（75.0%）。
近端肿瘤和放射治疗作为新辅助治疗的一部分的患者更有可能发生气管支气管损伤。对于术后发现的损伤患者，应采取积极的再次手术治疗方法。
