Management of Salivary Bypass Tube and Stent Migration in Pharyngoesophageal Microvascular Reconstruction

Abstract

Objective: Post-chemoradiation salvage surgery with pharyngoesophageal reconstruction may be associated with postop fistula, even with free tissue transfer. Salivary bypass tubes and stents have thus been used to minimize this complication, but migration is a real risk. We present our series of bypass tube and esophageal stent distal migrations and management.

Method: A retrospective chart review at a tertiary academic medical center identified those patients undergoing pharyngoesophageal salvage resection, simultaneous complex pharyngoesophageal reconstruction, and salivary bypass tube or esophageal stent placement. Demographics, surgical details and postop management of tube or stent migration distally into the GI tract were investigated.

Results: Distal migration of the salivary bypass tube was identified in 2 patients, and migration of the esophageal stent was identified in 1 patient. All cases were in the setting of complex pharyngoesophageal flap reconstruction after salvage surgical resection. Dates of migration discovery ranged from weeks to months postop. All patients were asymptomatic and without fistula formation, but with the tubes/stent radiographically confirmed in the GI tract. Management was via a team approach with our GI colleagues, and all salivary-channeling devices were successfully retrieved endoscopically, without complication.

Conclusion: Pharyngoesophageal reconstruction after salvage surgery carries the risk of fistula even in the setting of micro-vascular tissue transfer. To minimize this dreaded complication, salivary bypass tubes/stents may be used, but migration is a well-recognized risk. Our series presents successful management of such via a team approach.