Surviving cancer and tracheoesophageal fistula: Sandy Tovey’s journey

Sandy Tovey, a Maine native and grandmother of two, knew something wasn’t right. She had strange chest palpitations, trouble swallowing and a constant feeling that something was off. Doctors said it was acid reflux, even prescribing her medicine for heartburn. But the symptoms persisted. “I just didn’t feel like myself,” she said. “I kept telling them, something’s not right.”

For six months, she pushed for answers. Eventually, a specialist recommended an endoscopy, and that’s when they found it: esophageal cancer. The diagnosis was a shock, but finally, she had clarity and a path forward. It wasn’t until then that she learned that if you’ve had gastroesophageal reflux disease (GERD) for five years, you need to have an endoscopy to look for cancer.

Receiving a cancer diagnosis was difficult, but she remained hopeful. She began treatment immediately, including chemotherapy, radiation and then surgery in November 2021 to remove the tumor. “Everything looked great,” she said. “They got clean margins, and I felt hopeful.” But her road to recovery would prove far from over.

Two weeks after having her feeding tube removed, Tovey began having trouble swallowing again. The radiation had caused a stricture, an abnormal narrowing in her esophagus that made it difficult, sometimes impossible, to eat. She underwent dozens of endoscopic procedures to dilate or stretch the area; in fact, more than 40 in a single year. But the relief never lasted.

Eventually, she was referred to Dr. Shanda Blackmon, a Baylor Medicine thoracic surgeon known for her expertise in complex esophageal repairs. Tovey first started her care under Blackmon at Mayo Clinic and followed her to Baylor College of Medicine. “Dr. Blackmon wanted to try to teach me to self-dilate to keep the esophagus open rather than doing complicated surgery,” Tovey said. But before that could happen, a perforation occurred during a routine dilation, causing a rare and serious complication called a tracheoesophageal fistula (TEF).

What is a tracheoesophageal fistula (TEF)

A TEF is an abnormal connection between the trachea (windpipe) and the esophagus (food pipe). It can be present at birth or acquired later in life, often the result of prolonged intubation, trauma, infection or, as in Tovey’s case, complications from cancer and its treatment. With a TEF, food, liquid or air can pass between the two tubes in the wrong direction, often leading to severe coughing, choking, aspiration pneumonia and malnutrition.

“These are very complex cases,” said Blackmon, professor in the David J. Sugarbaker Division of Thoracic Surgery. “If a patient still has active cancer, treatment is mostly palliative. But if there’s no evidence of cancer, we can consider curative options.” One of those curative options is repair of the trachea and a later staged reconstruction of the esophagus.

A scientific marvel of care

Tovey was hospitalized in Maine, severely malnourished and unable to swallow. A stent was placed, but it damaged her trachea further. That’s when the decision was made to proceed with the complicated surgery with Blackmon at the Mayo Clinic.

“We’re proud to work with our interventional pulmonary and otolaryngology teams in a multidisciplinary approach here at the Baylor College of Medicine Lung Institute,”  Blackmon said. “Some patients have been told nothing can be done, but with high-volume experience, specialized anesthesia, ECMO support and iterative protocols, we can offer solutions others can’t.”

The surgery required multiple steps. First, multiple muscle flaps from her chest wall had to be used to patch the hole in the trachea. Next, the esophagus had to be diverted onto the chest and disconnected from the rest of her GI track. A feeding tube had to be placed, and she would remain dependent on that feeding tube until later reconstruction to connect the two ends back together could be performed. Often, these cases require operating through scar tissue, multiple disciplines, working together in the operating room and require a long recovery.

“She explained that we’d need to close off the esophagus to give my trachea time to heal,” Tovey said. That meant living with a colostomy-style esophageal diversion and drainage tube for over a year.

After surgery, Tovey required continuous bronchoscopy, nutritional support and careful monitoring. Blackmon partnered with The Brigham and Women’s Hospital to help monitor Tovey’s recovery until she was ready for the next stage of repair.

Rebuilding step by step

Even after the hole had closed, Tovey still had to manage a long drainage tube in her back . Fluid kept collecting in a space and the drain had to stay to keep her from becoming septic. “It was awful,” she recalled. “Every time I went in, they said to keep it. The day they finally removed it was the best day of my life.”

Determined to receive the best care possible, Tovey traveled to Houston to continue treatment with Blackmon who had joined the team at Baylor College of Medicine. After six months of preparation and testing, she underwent a complex reconstructive surgery in March 2025 at Baylor St. Luke’s Medical Center.

The surgery, known as a supercharged jejunal interposition, involved removing the esophageal diversion and creating a new connection using a segment of Tovey’s intestine. She spent over a month in the hospital recovering and is still working to transition off her feeding tube — but she can eat again, and for the first time in years, she sees a path forward. “It was extremely painful,” Tovey said. “But I knew she was the right person to do it.”

Hope for others

“I’ve been caring for patients with TEF for 20 years,” Blackmon said. “The outcomes we achieve aren’t miracles — they’re what I call scientarvels — scientific marvels born from experience, teamwork and a relentless drive to help our patients.”

The Baylor College of Medicine Lung Institute specializes in supporting patients with tracheoesophageal fistulas, offering second opinions and advanced care that may not be available elsewhere. With expertise in 3D-printed stents, ECMO support and reconstructive surgery, the multidisciplinary team provides tailored solutions for each patient’s unique situation.

After years of complications, hospital stays and difficult decisions, Tovey is slowly moving forward. She’s eating again, building strength and working toward the goal of coming off her feeding tube altogether.

“It’s been a long process,” Tovey said. “But I finally feel like I’m getting to the other side of it.”

Blackmon and Tovey exchange frequent calls and texts, making tweaks in Tovey’s care plan as she recovers from one of the most difficult surgeries cardiothoracic surgeons perform. “This is my greatest joy,” Blackmon said, as she occasionally joins Tovey and others in a virtual support group to try to help others cope with the stress of esophageal cancer and recovery from surgery.

By Tiffany Harston, senior communications associate in the Michael E. DeBakey Department of Surgery