Acquired Tracheoesophageal Fistula in Patient on Ventilator Is Better Managed Surgically

Abstract

Acquired tracheoesophageal fistula is fatal disease. This study investigates the efficacy of surgical treatment and patient selection. Twenty-one cases of acquired tracheoesophageal fistula (TEF), unrelated to malignancy, were investigated retrospectively between 2013 and 2021. All the patients (n = 4) who were not treated surgically died within 4 weeks. In cases who went to surgery, leukocytosis (mean = 15,118, SD6105 was not evident on the day of surgery (p = 0.102), high CRP (mean = 10, SD5.9, and p = 0.108), and the time between diagnosis and treatment (mean = 63 SD58.1 h, and p = 0.055), although not statistically significant, seemed to be effective on risk. It was found that the reason for intubation was due to cerebral trauma or non-traumatic disease (p = 0.028), and the age of over 40 (p = 0.009) was associated with TEF-related mortality. Microorganism growth was observed in the tracheal aspirate taken in 13 (76.5%) cases, which was not associated with mortality. Similarly, the presence of subcutaneous emphysema and mediastinitis at the time of diagnosis was not associated with mortality. Surgery is typically recommended in cases of TEF not associated with malignancy. Although surgical treatment is recommended for patients who can be weaned from mechanical ventilation, most patients die while awaiting weaning from ventilatory support with palliative therapy. In this series, it was observed that cases without surgical intervention had little probability of long-term survival. In our opinion, curative surgical treatment should not be delayed, even in patients who need mechanical ventilation.