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Management of refractory cervical anastomotic fistula after esophagectomy using the pectoralis major myocutaneous flap.
Braz J Otorhinolaryngol. 2020 Jun 15 [Online ahead of print]BJ

Abstract

INTRODUCTION

A refractory cervical anastomotic fistula which postoperatively remains unhealed for more than 2 months under conservative care severely impacts the quality of life of the patient and potentially leads to anastomotic stricture after the fistula heals. It is widely accepted that, to avoid this complication, refractory cervical anastomotic fistulas should undergo more aggressive treatments. However, when and which surgical intervention should be considered is unclear.

OBJECTIVE

This study was designed to evaluate the role of the pectoralis major myocutaneous flap in the management of refractory cervical anastomotic fistulas based on our experience of 6 cases and a literature review.

METHODS

Six patients diagnosed with refractory cervical anastomotic fistula after esophagectomy treated using pectoralis major myocutaneous flap transfer were included in the study. The clinical data, surgical details, and treatment outcome were retrospectively analyzed.

RESULTS

All patients survived the operations. One patient who had a circumferential anastomotic defect resulting from surgical exploration developed a mild fistula in the neo-anastomotic site in the 5th postoperative day, which healed after 7 days of conservative care. This patient developed an anastomotic stricture which was partially alleviated by an endoscopic anastomotic dilatation. All the other 5 patients had uneventful recoveries after operations and restored oral intake on the 10th-15th days after operation, and they tolerated normal diets without subsequent sequelae on follow-up. One patient developed both local and lung recurrence and died in 15 months after operation, while the other 5 patients survived with good tumor control during the follow-up of 25-53 months.

CONCLUSION

The satisfactory treatment outcome in our study demonstrates that pectoralis major myocutaneous flap reconstruction is a reliable management modality for refractory cervical anastomotic fistulas after esophagectomy, particularly for those patients who experienced persistent fistulas after conservative wound care and repeated wound closures.

Authors+Show Affiliations

Cancer Hospital of Jiangxi Province, Department of Head and Neck Surgery, Nanchang, Jiangxi, PR China.Cancer Hospital of Shantou University Medical College, Department of Gynecology, Shantou, Guangdong, PR China.Chaozhou People's Hospital, Department of Head and Neck Surgery, Chaozhou, Guangdong, PR China.Cancer Hospital of Shantou University Medical College, Department of Head and Neck Surgery, Shantou, Guangdong, PR China.Cancer Hospital of Shantou University Medical College, Department of Head and Neck Surgery, Shantou, Guangdong, PR China.Cancer Hospital of Shantou University Medical College, Department of Head and Neck Surgery, Shantou, Guangdong, PR China. Electronic address: penghanwei@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32600962

Citation

Deng, Lifei, et al. "Management of Refractory Cervical Anastomotic Fistula After Esophagectomy Using the Pectoralis Major Myocutaneous Flap." Brazilian Journal of Otorhinolaryngology, 2020.
Deng L, Li Y, Li W, et al. Management of refractory cervical anastomotic fistula after esophagectomy using the pectoralis major myocutaneous flap. Braz J Otorhinolaryngol. 2020.
Deng, L., Li, Y., Li, W., Liu, M., Xu, S., & Peng, H. (2020). Management of refractory cervical anastomotic fistula after esophagectomy using the pectoralis major myocutaneous flap. Brazilian Journal of Otorhinolaryngology. https://doi.org/10.1016/j.bjorl.2020.05.009
Deng L, et al. Management of Refractory Cervical Anastomotic Fistula After Esophagectomy Using the Pectoralis Major Myocutaneous Flap. Braz J Otorhinolaryngol. 2020 Jun 15; PubMed PMID: 32600962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of refractory cervical anastomotic fistula after esophagectomy using the pectoralis major myocutaneous flap. AU - Deng,Lifei, AU - Li,Yan, AU - Li,Weixiong, AU - Liu,Muyuan, AU - Xu,Shaowei, AU - Peng,Hanwei, Y1 - 2020/06/15/ PY - 2020/03/06/received PY - 2020/05/03/accepted PY - 2020/7/1/entrez KW - Anastomotic leakage KW - Esofagectomia KW - Esophagectomy KW - Myocutaneous flap KW - Músculo peitoral KW - Pectoralis muscle KW - Reconstruction KW - Reconstrução KW - Retalho miocutâneo KW - Vazamento anastomótico JF - Brazilian journal of otorhinolaryngology JO - Braz J Otorhinolaryngol N2 - INTRODUCTION: A refractory cervical anastomotic fistula which postoperatively remains unhealed for more than 2 months under conservative care severely impacts the quality of life of the patient and potentially leads to anastomotic stricture after the fistula heals. It is widely accepted that, to avoid this complication, refractory cervical anastomotic fistulas should undergo more aggressive treatments. However, when and which surgical intervention should be considered is unclear. OBJECTIVE: This study was designed to evaluate the role of the pectoralis major myocutaneous flap in the management of refractory cervical anastomotic fistulas based on our experience of 6 cases and a literature review. METHODS: Six patients diagnosed with refractory cervical anastomotic fistula after esophagectomy treated using pectoralis major myocutaneous flap transfer were included in the study. The clinical data, surgical details, and treatment outcome were retrospectively analyzed. RESULTS: All patients survived the operations. One patient who had a circumferential anastomotic defect resulting from surgical exploration developed a mild fistula in the neo-anastomotic site in the 5th postoperative day, which healed after 7 days of conservative care. This patient developed an anastomotic stricture which was partially alleviated by an endoscopic anastomotic dilatation. All the other 5 patients had uneventful recoveries after operations and restored oral intake on the 10th-15th days after operation, and they tolerated normal diets without subsequent sequelae on follow-up. One patient developed both local and lung recurrence and died in 15 months after operation, while the other 5 patients survived with good tumor control during the follow-up of 25-53 months. CONCLUSION: The satisfactory treatment outcome in our study demonstrates that pectoralis major myocutaneous flap reconstruction is a reliable management modality for refractory cervical anastomotic fistulas after esophagectomy, particularly for those patients who experienced persistent fistulas after conservative wound care and repeated wound closures. SN - 1808-8686 UR - https://www.unboundmedicine.com/medline/citation/32600962/Management_of_refractory_cervical_anastomotic_fistula_after_esophagectomy_using_the_pectoralis_major_myocutaneous_flap L2 - https://linkinghub.elsevier.com/retrieve/pii/S1808-8694(20)30067-7 DB - PRIME DP - Unbound Medicine ER -
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