High incidence of tracheobronchial diverticulum in esophageal cancer patients: a retrospective survey alerting pitfall d
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ORIGINAL ARTICLE
High incidence of tracheobronchial diverticulum in esophageal cancer patients: a retrospective survey alerting pitfall during thoracoscopic esophagectomy Noriyuki Nishiwaki1 · Kazuhiro Noma1 · Naoaki Maeda1 · Shunsuke Tanabe1 · Kazufumi Sakurama1,2 · Yasuhiro Shirakawa1 · Toshiyoshi Fujiwara1 Received: 7 May 2020 / Accepted: 22 June 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives Although tracheobronchial diverticulum (DV) rarely cause problems, attention should be paid during esophagectomy, which requires careful dissection around the trachea and bronchi. Here, we retrospectively review cases of tracheobronchial DVs among esophageal cancer patients and report two cases of bronchial DV injury during thoracoscopic esophagectomy that were successfully repaired. Methods The thin-section CT images of esophageal cancer patients who underwent thoracoscopic esophagectomy from January 2013 to December 2015 were retrospectively reviewed. The localization, number, and size (largest axial diameter) of all detected DVs were recorded. Results A total of 180 patients were enrolled in this study. The incidence of tracheal DV was 5.0%, and that of bronchial DV was 40.0%. The median diameter of the tracheal diverticula was 2.45 [interquartile range (IQR) 2.00–8.17] mm and that of the bronchial diverticula was 1.90 (IQR 1.51–2.46) mm. All tracheal diverticula presented at the right tracheal wall 4.5–6.0 cm below the vocal cords; bronchial diverticula presented at the subcarinal lesions. We experienced two cases with bronchial diverticulum injuries during thoracoscopic esophagectomy, which were repaired by primary closure and confirmed that there was no air leak. No postoperative complications associated with bronchial injury occurred in either patient. Conclusion Since tracheobronchial DVs are not as rare as previously thought, careful evaluation of thin-slice CT scans is necessary before thoracoscopic esophagectomy. If a tracheobronchial DV is injured during surgery, it is important to carefully repair it and confirm that there is no air leak to avoid complications. Keywords Tracheobronchial diverticulum · Esophageal cancer · Thoracoscopic esophagectomy
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01421-3) contains supplementary material, which is available to authorized users. * Kazuhiro Noma [email protected]‑u.ac.jp 1
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2‑5‑1 Shikata‑cho, Kita‑ku, Okayama 700‑8558, Japan
Shigei Medical Research Institute, Okayama, Japan
2
A tracheobronchial diverticulum (DV) is commonly asymptomatic and incidentally detected by imaging methods. There are several reports of esophageal cancer patients with a tracheal DV, which leads to a high risk of injuring the DV during lymph node dissection [1–3]; whereas, bronchial DV injuries have never been reported. Although bronchial DVs
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