Creation of a pharyngeal coecostomy and reconstruction of the trachea using a supraclavicular island flap for esophagotracheal fistula after radiotherapy for advanced esophageal carcinoma

Introduction The following case describes the two-stage complex surgical treatment of a wide esophagotracheal fistula after abdominothoracic resection and gastric pull-up of an esophageal carcinoma. This was followed by radio-chemotherapy and immunotherapy for early recurrence. In the presence of a persistent residual tumor on PET imaging and wide esophageotracheal fistulas 10 cm in length, the patient was presented to the local ENT and visceral surgery department. The patient underwent a combined transthoracic residual esophagectomy with partial resection of the gastric interposition and laryngectomy in the first stage in February 2023. The posterior wall of the trachea was treated with a supraclavicular island flap (SCAIF) from the right side. A pharyngostomy was placed on the left side. No residual tumor was found in the resection specimen. In June 2023, a subcutaneous colonic pull-up with end-to-end anastomosis of the cecum to the pharyngostomy, a side-to-side ascendo jejunostomy and a side-to-side ileostransversostomy were performed to restore the food passage.