Colonic interposition after esophagectomy for cancer

Abstract

Hypothesis: The use of colonic interposition in esophageal replacement after esophagectomy for cancer results in similar morbidity, mortality, and long-term outcome compared with gastric transposition. Design: Prospectively collected database on patients with esophageal cancer from January 1, 1982, through December 31, 2000. Setting: Academic university hospital department of surgery. Patients: We compared 42 patients who underwent colonic interposition (colon group) with 959 patients who underwent gastric transposition (stomach group) after esophagectomy. Main Outcome Measures: Morbidity, mortality, and long-term survival. Results: Greater blood loss (median, 1000 vs 700 mL; P<.001) and longer operation duration (median, 270 vs 225 minutes; P<.001) were encountered in the colon group. We found no difference in cardiopulmonary complications, but we found significantly greater incidences of anastomotic leakage (14.3% vs 3.9%; P=.007) and intraabdominal septic complications (9.5% vs 0.2%; P<.001) in the colon group. Conduit ischemia developed in 5 patients (0.5%) in the stomach group, 3 of whom underwent successful staged reconstruction with colon. One patient (2.4%) in the colon group was found to have conduit ischemia and died. Hospital mortality rates included 7 patients (16.7%) from the colon group and 102 (10.6%) from the stomach group (P=.21). These figures improved to 0 and 27 (5.5%), respectively, in the second half of the study period (P>.99). Median survival was 12.8 and 10.4 months in the stomach and colon groups, respectively (P=.4). Conclusions: Colonic interposition is a more complex procedure with increased morbidity, compared with gastric transposition. Overall mortality and survival, however, were similar to those for gastric transposition.