Tracheoesophageal Fistula After Esophagectomy: Two Case Presentations and Management Challenges

Abstract Background Tracheoesophageal fistula (TEF) is a rare but serious complication following esophagectomy. It presents significant diagnostic and therapeutic challenges due to its complex anatomy and severe impact on patient outcomes. We report two cases of TEF occurring after curative esophageal cancer surgery. Methods We retrospectively reviewed two patients who developed TEF after esophagectomy. One patient underwent trans-thoracic esophagectomy with cervical anastomosis for adenosquamous cell carcinoma of the esophagus. The other underwent thoracoscopic Ivor-Lewis esophagectomy for adenocarcinoma of the esophagogastric junction. Clinical courses, radiologic and endoscopic findings, and management strategies were reviewed. Results In Case 1, TEF was detected on postoperative day (POD) 26 and managed surgically with a muscle rotation flap and drainage, achieving closure by POD 74. In Case 2, TEF developed following pneumonia and was initially managed conservatively with endoscopic stent insertion and feeding tube placement. Despite subsequent hiatal hernia repair and jejunostomy insertion to promote healing, complete fistula closure was not achieved. The patient later developed recurrence near the adrenal gland and received palliative radiotherapy, ultimately resulting in hopeless discharge. Conclusion TEF following esophagectomy remains a rare but challenging complication with no standardized treatment. Early diagnosis and individualized management—including surgical repair, endoscopic intervention, and supportive care—are critical. These two cases illustrate that timely surgical intervention may achieve fistula resolution, while prolonged endoscopic and palliative approaches may be necessary in complex or recurrent cases. Multidisciplinary decision-making is essential to optimize outcomes for patients with TEF.