Abstract
PURPOSE: Aortoesophageal fistula (AEF) after esophagectomy is a rare but catastrophic complication, often occurring after anastomotic leakage and mediastinal contamination. Evidence regarding fatal trajectories and rescue failure points remains limited. METHODS: We performed a retrospective, single-center study among esophageal cancer patients who developed AEF after esophagectomy between 2013 and 2024. Cases were identified from institutional databases and mortality records, followed by manual screening. Clinical course, antecedent complications, diagnostic workup, rescue interventions, and causes of death were summarized descriptively. RESULTS: Among 5543 esophagectomies, 17 patients (0.31%) developed AEF: 16 fatal (94.1%) and 1 survivor (5.9%). All were male, median age 63 years. Anastomotic leak occurred in 16 patients (94.1%), all with mediastinal infection. Sentinel bleeding preceded hemorrhage in 14 patients (82.4%); the median interval to fatal hemorrhage was 1 day. CONCLUSIONS: Post-esophagectomy AEF is highly lethal. Sentinel bleeding represents a critical intervention window. Prompt recognition and multidisciplinary escalation may enable survival even in high-risk patients.