Lateral cervicotomic approach effective and safe in acquired benign tracheoesophageal fistulas

The study is published in the American Journal of Otolaryngology.

Despite improvements of diagnosis and management, acquired benign tracheoesophageal fistulas (AB-TEFs) remain a challenging clinical problem and a life-threating condition.

Hence, Matteo Fermi and colleagues from the Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy carried out the present study with the objective to review the early results and the long-term outcomes after surgical treatment of cervical AB-TEFs treated in our institution during the last 9 years.

This retrospective study included patients who underwent transcervical repair of benign cervical AB-TEFs. Patients were identified from a prospectively filled electronic database which included patients' demographics, medical history, disease presentation, prior treatments, operative report, morbidity and mortality, hospital stay, postoperative results and follow-up information.

The results showed that-

a. A total of 13 patients affected by cervical AB-TEF were treated.

b. Most of the patients (91%) in our series were treated with a lateral cervicotomic approach with interposition of either sternocleidomastoid muscle flap (72.7%) or pectoralis major myocutaneous flap (9.1%) or infrahyoid muscle flap (9.1%).

c. The univariate analysis of showed that the etiology and surgical technique were significantly associated with immediate postoperative outcome.

d. Esophageal diversion was removed in all patients but 3 due to their neurological status, which was the only significant factor related to post-operative oral-intake (p =0.016).

e. 2 (18.2%) failures of the reconstruction, which occurred in patients previously treated with chemoradiation for head and neck malignancies were observed.

f. None of the remaining patients (72.8%) relapsed after a long-term follow-up restoring a normal oral diet was restored.

Therefore, the authors concluded that "the lateral cervicotomic approach with sternocleidomastoid flap interposition showed its effectiveness and safety in the treatment of AB-TEFs in our single-institution experience."