Waheed HZ, Huang CQ, Bao YY, Chen Z, Chen HC, Cao ZZ, Zhong JT, Ye P, Fu SQ, Zhou SH. Successful cure of a patient with tracheoesophageal fistula in cervical esophageal cancer: A case report and review of literature. World J Clin Oncol 2025; 16(8): 109217 [DOI: 10.5306/wjco.v16.i8.109217]
Corresponding Author of This Article
Shui-Hong Zhou, Chief, Chief Physician, Head, PhD, Professor, Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. 1190051@zju.edu.cn
Research Domain of This Article
Otorhinolaryngology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Haider Zuhair Waheed, Can-Qiang Huang, Yang-Yang Bao, Zhe Chen, Heng-Chao Chen, Zai-Zai Cao, Jiang-Tao Zhong, Peng Ye, Shui-Qiao Fu, Shui-Hong Zhou, Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Peng Ye, Department of General Thoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Shui-Qiao Fu, Surgical Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: Waheed HZ contributed to writing—original draft preparation, conceptualization; Zhou SH contributed to writing—review and editing for important intellectual content and final approval of the version to be published; Huang CQ, Bao YY, Chen Z, Chen HC, Cao ZZ, Zhong JT, Ye P, and Fu SQ contributed to investigation, data curation; All authors have read and agreed to the published version of the manuscript.
Supported by the Key R&D Program of Zhejiang, No. 2023C03066; and National natural science foundation of China, No. 82471148.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shui-Hong Zhou, Chief, Chief Physician, Head, PhD, Professor, Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. 1190051@zju.edu.cn
Received: May 7, 2025 Revised: June 8, 2025 Accepted: July 25, 2025 Published online: August 24, 2025 Processing time: 105 Days and 18.7 Hours
Abstract
BACKGROUND
Tracheoesophageal fistula (TEF) is a life-threatening complication of advanced esophageal squamous cell carcinoma (ESCC). Cervical ESCC is rare and frequently diagnosed at an advanced stage. Managing cervical esophageal cancer (CEC) is challenging, requiring intervention by a multidisciplinary team (MDT) and innovative surgical management.
CASE SUMMARY
Here, we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days, who developed TEF secondary to recurrent ESCC after chemoradiotherapy. He underwent total pharyngolaryngoesophagectomy, left thyroidectomy, and lymphadenectomy. Gastric pull-up was performed to restore gastrointestinal continuity, and a 7 cm × 5 cm supraclavicular artery island flap (SCAIF) was used to reconstruct the lower tracheal defect. Despite severe postoperative complications, he recovered by successful management by a MDT. A 7 cm × 6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect. The patient recovered, regaining the ability to eat and breathe effectively. At the 27-month follow-up, he was alive without recurrence or metastasis.
CONCLUSION
This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.
Core Tip: This article presents a unique approach to managing tracheoesophageal fistula (TEF) secondary to recurrent advanced-stage cervical esophageal cancer after chemoradiotherapy. There have been few reports regarding radical surgery for TEF. This is the first report of supraclavicular artery island flap (SCAIF) reconstruction for TEF repair and salvage surgery using gastric pull-up. The SCAIF was used to connect the tracheal stump located in the mediastinum, creating a permanent tracheostomy. The multidisciplinary team was pivotal in handling severe postoperative complications, including gastric conduit necrosis in the neck, managed with a U-shaped pectoralis major myocutaneous flap. We achieved optimal cure and significant improvement in the patient’s quality of life.
