Masayuki Watanabe1,2, Michio Sato3,4, Minoru Fukuchi3,5, Hiroyuki Kato3,6, Hisahiro Matsubara3,7. 1. The Japan Esophageal Society, 2-3-13 Taihei, Sumida-ku, Tokyo, 103-0012, Japan. masayuki.watanabe@jfcr.or.jp. 2. Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. masayuki.watanabe@jfcr.or.jp. 3. The Japan Esophageal Society, 2-3-13 Taihei, Sumida-ku, Tokyo, 103-0012, Japan. 4. Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan. 5. Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Koun-cho, Maebashi, Gunma, 371-0025, Japan. 6. Department of Surgery, Kiryu Kosei Hospital, 16-3 Orihime-machi, Kiryu, Gunma, 376-0024, Japan. 7. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
Abstract
BACKGROUND: Aortoesophageal fistula (AEF) is a life-threatening late complication that can occur after thoracic endovascular aortic repair (TEVAR). More data are required to identify the optimal treatment strategy for AEF developed after TEVAR. The aim of this study was to clarify the current status of surgical treatments for AEF developed after TEVAR and the outcomes of these treatments. METHODS: The Japan Esophageal Society conducted a questionnaire survey targeting authorized or semi-authorized institutes at Authorized Institutes for Board Certified Esophageal Surgeons. Thirty-nine patients with AEF developed after TEVAR were identified from 15 institutes. Data on patient demographics, treatment performed, and survival rate were obtained by the questionnaire. The Kaplan-Meier method was used for survival analysis and differences in the survival rates. RESULTS: Esophagectomy and aortic replacement were performed in 32 and 22 patients, respectively, and 22 underwent both procedures. Postoperative complications were observed in 24 patients (75.0%). Complications with Clavien-Dindo Grade III or higher were observed in 53.1% of patients. Operative and hospital mortality rates were 3.1% and 18.8%, respectively. The survival rate in patients who underwent esophagectomy was higher than in those who did not (P < 0.0001). The survival of patients who underwent both esophagectomy and aortic replacement was also higher than in those who did not (P < 0.0001). CONCLUSION: Esophagectomy combined with aortic replacement can offer a long-term treatment strategy with higher survival rates in patients who develop AEF after TEVAR. Because of the high incidence of postoperative morbidity and mortality, these types of surgery should only be performed in centers with both experienced esophageal and cardiovascular surgical teams.
BACKGROUND:Aortoesophageal fistula (AEF) is a life-threatening late complication that can occur after thoracic endovascular aortic repair (TEVAR). More data are required to identify the optimal treatment strategy for AEF developed after TEVAR. The aim of this study was to clarify the current status of surgical treatments for AEF developed after TEVAR and the outcomes of these treatments. METHODS: The Japan Esophageal Society conducted a questionnaire survey targeting authorized or semi-authorized institutes at Authorized Institutes for Board Certified Esophageal Surgeons. Thirty-nine patients with AEF developed after TEVAR were identified from 15 institutes. Data on patient demographics, treatment performed, and survival rate were obtained by the questionnaire. The Kaplan-Meier method was used for survival analysis and differences in the survival rates. RESULTS: Esophagectomy and aortic replacement were performed in 32 and 22 patients, respectively, and 22 underwent both procedures. Postoperative complications were observed in 24 patients (75.0%). Complications with Clavien-Dindo Grade III or higher were observed in 53.1% of patients. Operative and hospital mortality rates were 3.1% and 18.8%, respectively. The survival rate in patients who underwent esophagectomy was higher than in those who did not (P < 0.0001). The survival of patients who underwent both esophagectomy and aortic replacement was also higher than in those who did not (P < 0.0001). CONCLUSION: Esophagectomy combined with aortic replacement can offer a long-term treatment strategy with higher survival rates in patients who develop AEF after TEVAR. Because of the high incidence of postoperative morbidity and mortality, these types of surgery should only be performed in centers with both experienced esophageal and cardiovascular surgical teams.
Authors: R Chiesa; G Melissano; E M Marone; M M Marrocco-Trischitta; A Kahlberg Journal: Eur J Vasc Endovasc Surg Date: 2010-01-21 Impact factor: 7.069
Authors: Frederik H W Jonker; Felix J V Schlösser; Frans L Moll; Joost A van Herwaarden; Jeffrey E Indes; Hence J M Verhagen; Bart E Muhs Journal: J Endovasc Ther Date: 2009-08 Impact factor: 3.487
Authors: Frederik H W Jonker; Robin Heijmen; Santi Trimarchi; Hence J M Verhagen; Frans L Moll; Bart E Muhs Journal: J Vasc Surg Date: 2009-05-29 Impact factor: 4.268