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.

Method: clinical case description

Results: The first stage surgery including laryngectomy and reconstruction by SCAIF allowed primary closure of the fistula. The second operation in June 2023 successfully restored the food passage. He is currently able to feed himself sufficiently orally and is undergoing tumor follow-up care.

Discussion: This case is the first case described in which successful reconstruction of the posterior tracheal wall in long esophagotracheal fistula was performed by SCAIF. Due to the postherapeutic massive fibrosis of the upper mediastinum, a colonic interposition was not possible, but required a two-stage reconstruction using a subcutaneous interposition of the right hemicolon.

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