433. SURGICAL REPAIR OF TRACHEOESOPHAGEAL FISTULAS AFTER ESOPHAGECTOMY WITH BOVINE PERICARDIUM: SURGICAL TECHNIQUE AND OUTCOMES
Bibliographic record
Abstract
Abstract Background Tracheoesophageal fistula (TEF) is a rare but devastating complication after esophagectomy. The anatomical and physiological particularities of this complication as well as the nutritional and overall status of these patients make these cases extremely challenging to manage and there is no consensus treatment. This case series reflects on the experience of a high-volume academic center with a focus to identify approaches associated with successful repair. Methods Patients who underwent elective esophagectomy for cancer between 01/2014 and 01/2025 were identified from a prospectively collected database at a high-volume referral center. Data on demographics, comorbidities, surgical techniques, intra and postoperative complications, length of stay, and mortality were collected. Descriptive statistics were used to analyze patient characteristics and outcomes. Results Of 692 patients in the database, 9 developed post-operative TEF (1.3%). Mean age 70 years and median CCI 5 (IQR 5–6). Six patients (67%) underwent neoadjuvant therapy (chemoradiotherapy n = 4). Resection was minimally invasive in 5 cases (56%) with an intra-thoracic anastomosis in 6 (67%). Airway defect to right main bronchus in 6 cases (67%) and trachea in 3 (33%). Surgical repair of TEF was performed with a bovine pericardium patch in all cases. Median length of stay was 31 days (IQR 16–72). Clavien-Dindo grade IV morbidity occurred in 6 cases (67%) and in hospital mortality in 2 (22%). Conclusion TEF after esophagectomy is a rare but challenging complication that entails high degree of morbidity with reintervention and multi organ dysfunction. The preferred method of repair of the airway defect was the use of a bovine pericardial patch, buttressed with a muscle flap in most cases. Continuity of the upper digestive tract was maintained in all cases and intrahospital mortality was acceptable. TEF management was resource-intensive with prolonged length of hospital stays but favourable early outcomes were possible with a prompt and aggressive surgical approach and multidisciplinary perioperative care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".