Waheed Haider Zuhair, Huang Can-Qiang, Bao Yang-Yang, Chen Zhe, Chen Heng-Chao, Cao Zai-Zai, Zhong Jiang-Tao, Ye Peng, Fu Shui-Qiao, Zhou Shui-Hong
Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
Department of General Thoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
World J Clin Oncol. 2025 Aug 24;16(8):109217. doi: 10.5306/wjco.v16.i8.109217.
Tracheoesophageal fistula (TEF) is a life-threatening complication of advanced esophageal squamous cell carcinoma (ESCC). Cervical ESCC is rare and frequently diagnosed at an advanced stage. Managing cervical esophageal cancer (CEC) is challenging, requiring intervention by a multidisciplinary team (MDT) and innovative surgical management.
Here, we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days, who developed TEF secondary to recurrent ESCC after chemoradiotherapy. He underwent total pharyngolaryngoesophagectomy, left thyroidectomy, and lymphadenectomy. Gastric pull-up was performed to restore gastrointestinal continuity, and a 7 cm × 5 cm supraclavicular artery island flap (SCAIF) was used to reconstruct the lower tracheal defect. Despite severe postoperative complications, he recovered by successful management by a MDT. A 7 cm × 6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect. The patient recovered, regaining the ability to eat and breathe effectively. At the 27-month follow-up, he was alive without recurrence or metastasis.
This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.
气管食管瘘（TEF）是晚期食管鳞状细胞癌（ESCC）的一种危及生命的并发症。颈段ESCC较为罕见，且常于晚期被诊断出来。治疗颈段食管癌（CEC）具有挑战性，需要多学科团队（MDT）进行干预并采用创新的手术管理方法。
在此，我们报告一名59岁男性患者，有5个月的CEC病史，进食困难超过20天，在放化疗后因复发性ESCC继发TEF。他接受了全喉咽食管切除术、左侧甲状腺切除术和淋巴结清扫术。进行了胃上提术以恢复胃肠道连续性，并使用一块7厘米×5厘米的锁骨下动脉岛状皮瓣（SCAIF）修复气管下段缺损。尽管术后出现严重并发症，但通过MDT的成功管理，他得以康复。一块7厘米×6厘米的胸大肌肌皮瓣成功用于修复坏死的胃管道缺损。患者康复，恢复了有效进食和呼吸的能力。在27个月的随访中，他存活且无复发或转移。
本研究强调了胃上提术和SCAIF重建术在治疗复发性ESCC继发TEF中的疗效。
