A Staged Surgical Treatment for Aortoesophageal Fistula in Esophageal Cancer

ABSTRACT

An aortoesophageal fistula (AEF) is a rare and lethal disorder. However, aortic surgery is usually performed with extracorporeal circulation, and there is a high rate of surgical complications and mortality. This report describes a case of AEF caused by radiotherapy for esophageal cancer. A 59-year-old man was treated with preoperative chemoradiation, and developed a tracheoesophageal fistula (TEF) 3 months later (3 cycles of cisplatin and 5-fluorouracil). He complained of hemoptysis and hematemesis. Based on computed tomography and diagnostic endoscopic findings, he was diagnosed with an AEF and TEF, and initially underwent endovascular coiling, which failed. Because of bleeding, emergent thoracic endovascular aortic repair was performed. Esophageal resection and reconstruction were performed 45 days later to control mediastinal inflammation. The patient was followed up as an outpatient. He has had no recurrence of cancer or any further complications.