Postoperative Esophageal Leaks in Malignant Pathology - Optimal Management: A Systematic Review

Application of ozonated water for treatment of gastro-thoracic fistula after comprehensive esophageal squamous cell carcinoma therapy: A case report

BACKGROUND

Gastro-thoracic fistula is a serious complication after radical surgery for esophageal cancer, and a conservative approach or endoscopic intervention is commonly applied to treat most cases.

CASE SUMMARY

Here we describe the case of a patient with a gastro-thoracic fistula which could not be closed during gastroscopy after receiving postoperative radiotherapy, together with severe multiple drug-resistant bacterial infection and chest wall fistula. The abscess was drained and local irrigation applied with ozonated water, together with oral ozonated water, which achieved a good effect and highlighted a new way to cure fistula in such patients.

CONCLUSION

Patients with gastro-thoracic fistula that cannot be closed and severe infection can be treated by drainage and flushing with ozonated water.

Tubular anastomosis with full-thickness discontinuous tension-reduction suture can reduce incidence of cervical anastomotic fistula after surgery for esophageal cancer

BACKGROUND

Anastomotic fistula is the most common serious complication after operation for esophageal cancer. This study retrospectively analyzed the clinical data of patients undergoing radical resection of esophageal carcinoma at our department, identified the relevant risk factors for anastomotic fistula, and investigated the effects of tubular anastomosis with full-thickness discontinuous tension-reduction suture for the prevention of anastomotic fistula.

AIM

To analyze the risk factors affecting the occurrence of cervical anastomotic fistula after surgery of esophageal cancer, and to explore the safety and effectiveness of tubular anastomosis with full-thickness discontinuous tension-reduction suture on anastomotic fistula.

METHODS

The clinical data of 544 patients with esophageal squamous cell carcinoma undergoing radical surgery from May 2014 to December 2018 at the Department of Thoracic Surgery, Anyang Tumor Hospital were retrospectively analyzed, and possible factors related to the occurrence of cervical anastomotic fistula were identified. Single-factor and multi-factor Logistic regression analyses were performed to determine the independent risk factors for the occurrence of cervical anastomotic fistula.

RESULTS

The patient's age, diabetes history, duration of operation (> 300 min), and full-thickness discontinuous suture after tubular anastomosis were independent risk factors for the occurrence of postoperative anastomotic fistula. Among them, tubular anastomosis with full-thickness discontinuous tension-reduction suture was beneficial to reduce the incidence of postoperative cervical anastomotic fistula (6.1% vs 13.1%, P < 0.05).

CONCLUSION

It is safe and effective to prevent cervical anastomotic fistula by using tubular anastomosis with full-thickness discontinuous tension-reduction suture.