Abstract
Tracheoesophageal fistula (TEF) and trachea-conduit fistula (TCF) after esophagectomy are rare but life-threatening complications. Large or multiple fistulas are difficult to treat when standard resection and tracheal reconstruction are not feasible. A 70-year-old man developed an anastomotic stricture after Ivor-Lewis esophagectomy for squamous cell carcinoma and underwent repeated balloon dilatations and stent placement. Progressive tissue injury resulted in 1 TCF and 2 large TEFs. Salvage surgery included stent removal, distal conduit takedown, proximal conduit closure, substernal colon interposition, and esophagocolostomy. The esophagus-proximal gastric conduit segment containing the fistulas was preserved in situ as a neo-posterior tracheal wall. Oral intake was resumed after esophagography on postoperative day 6, and bronchoscopy confirmed a viable blind pouch. Preserving the esophagus-conduit segment in situ may provide effective airway-alimentary separation in selected patients with extensive multifocal TEF/TCF. In highly selected patients, this salvage option for airway-alimentary separation when standard resection and reconstruction carry prohibitive risk. Given the limited survival in this case, it is not intended as a definitive or broadly generalizable reconstruction.