490 COLONIC INTERPOSITION FOR ESOPHAGEAL REPLACEMENT AFTER ESOPHAGECTOMY FOR CANCER—A SINGLE CENTER EXPERIENCE

Abstract The standard esophageal replacement after esophagectomy for cancer treatment is a gastric conduit, as it is a simpler technique than the other options available, requiring only one anastomosis. However, when the stomach is not available, a left- or right colon graft interposition can be performed. The purpose of this study was to review our experience with colon interposition following esophagectomy for cancer and assess the surgical outcomes. Methods The clinical data and surgical outcomes form patients who underwent esophagectomy with colon interposition for cancer treatment, in a single institution, between January 1990 and December 2017. The results were compared with cases with gastric reconstruction. Results From January 1990 and December 2017, 25 cases of transhiatal esophagectomy with colon interposition were identified. In the same period, 97 cases of transhiatal esophagectomy with gastric pull-up were also performed. The patient’s clinical data and surgical outcomes are presented in Table 1. The indication for performing a colon interposition was positive distal margin in 87% of cases, gastric conduit ischemia in 8,7% and prior gastric surgery in 4,3%. The most common pull-up route was the posterior mediastinum (87%). Conclusion Our results are in line with the literature and demonstrate that colon interposition after esophagectomy is feasible and, despite having a significant morbimortality, appears to be a valuable alternative for the challenging situation where the stomach is not available.

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PS01.166: COLONIC INTERPOSITION FOR ESOPHAGEAL REPLACEMENT AFTER ESOPHAGECTOMY FOR CANCER: A SINGLE CENTER EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.166 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 96-96

Author(s):

Flávio Sabino ◽

Marco Guimaraes ◽

Daniel Fernandes ◽

Carlos Eduardo Pinto ◽

Luis Felipe Pinto ◽

...

Keyword(s):

Conflicts Of Interest ◽

Neoadjuvant Treatment ◽

Pulmonary Complications ◽

Transhiatal Esophagectomy ◽

Colon Interposition ◽

Esophageal Replacement ◽

Surgical Morbidity ◽

Single Center Experience ◽

Challenging Situation ◽

Esophagectomy For Cancer

Abstract Background The method of choice for esophageal replacement after esophagectomy for cancer is the gastric tube. However when the stomach is not available a colon graft interposition can be performed. The purpose of this retrospective study was to review our experience with colon interposition following esophagectomy for cancer and to assess the early surgical outcomes. Methods We reviewed clinical data from 26 consecutive patients who underwent colon interposition after esophagectomy for cancer between January 1990 and December 2017 at the Brazilian National Cancer Institute. Outcomes were compared with data in international publications on colon interposition. Results There were 22 (85%) males and 4 females with a mean age of 56 years (range, 28 to 79 years). Indications were adenocarcinoma in 21 (81%) and squamous cell carcinoma in 5 (19%). Seven (30%) patients received neoadjuvant treatment: in 3 cases chemotherapy and in 4 patients chemoradiation. Transhiatal esophagectomy and transthoracic esophagectomy were performed in 21 (81%) and 5 patients, respectively. The mean operative time was 389 min (range 120–660 min). The most common option for colon conduit was the left colon (63%). We performed hand-sewn anastomosis in the neck in all cases. Surgical morbidity was 65%, most commonly due to pulmonary complications. Anastomotic leakage occurred in 13 patients (50%). One case graft necrosis were observed and 9 (35%) reoperations were necessary. In-hospital mortality was 15%. Conclusion Our results are in line with the literature and demonstrate that colon interposition after esophagectomy is feasible and, despite having a significant morbimortality, appears to be a valuable alternative for the challenging situation where the stomach is not available. Disclosure All authors have declared no conflicts of interest.

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THE EXPERIENCE OF ESOPHAGEAL REPLACEMENT BY COLON INTERPOSITION IN STEPWISE TREATMENT OF ESOPHAGOPLEURALFISTULA

Clinical anatomy and operative surgery ◽

10.24061/1727-0847.10.3.2011.11 ◽

2011 ◽

Vol 10 (3) ◽

pp. 52-57

Author(s):

V. T. Mal'kevich ◽

V. V. Zharkov ◽

A. F. Rylyuk ◽

I. A. Il'in

Keyword(s):

Colon Interposition ◽

Esophageal Replacement

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Impact of chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN) on cancer treatment outcomes: An overview about well-established and recently emerging clinical data

Critical Reviews in Oncology/Hematology ◽

10.1016/j.critrevonc.2017.11.005 ◽

2017 ◽

Vol 120 ◽

pp. 163-179 ◽

Cited By ~ 26

Author(s):

Yassine Lalami ◽

Jean Klastersky

Keyword(s):

Febrile Neutropenia ◽

Cancer Treatment ◽

Treatment Outcomes ◽

Clinical Data ◽

Chemotherapy Induced Neutropenia

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469 ASSESSMENT OF PERFUSION OF GASTRIC CONDUIT AND PROXIMAL ESOPHAGEAL STUMP BY INDOCYANINE GREEN FLUORESCENCE IMAGING IN PATIENTS UNDERGOING ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doab052.469 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Subramanyeshwar Rao Thammineedi

Keyword(s):

Indocyanine Green ◽

Fluorescence Imaging ◽

Visual Inspection ◽

Near Infrared ◽

Infrared Camera ◽

Visual Assessment ◽

Transhiatal Esophagectomy ◽

Gastric Conduit ◽

Indocyanine Green Fluorescence ◽

Laparoscopic Assisted

Abstract Post esophagectomy anastomotic leakage and stricture are crucial factors in determining morbidity and mortality. Good vascularity of the gastric conduit is essential to avoid this complications. This prospective study assesses the utility of intraoperative indocyanine green (ICG) fluorescence imaging to determine gastric conduit vascularity in patients undergoing esophagectomy. Methods Thirteen consecutive patients who were undergoing esophagectomy for carcinoma middle, lower third esophagus or gastro-esophageal junction from August 2019 to September 2019, were included. Three patients underwent laparoscopic-assisted transhiatal esophagectomy, ten thoraco-laparoscopic assisted esophagectomy. Reconstruction was done by gastric pull up via posterior mediastinal route. Vascularity of gastric conduit was assessed by the near-infrared camera using ICG. Results On visual assessment of perfusion at the tip of gastric conduit, it was dusky in 11 patients, pink in two. Fuorescence imaging showed inadequate perfusion at the tip of conduit in 12 patients, needing revision. In one patient visual inspection showed adequate perfusion, but ICG disclosed poor vascularity requiring revision of the conduit’s tip. Resection of the devitalized portion of the proximal esophageal stump was needed in 5 patients both by visual and ICG assessment. The median time to appearance of blush from the time of injection of dye was 15 seconds (10 to 23 seconds). Conclusion Visual inspection of the gastric conduit vascularity can underestimate perfusion and hence can compromise resection of the devitalized part. ICG fluorescence imaging is more objective and promising means to ascertain the vascularity of gastric conduit during an esophagectomy. It could complement the visual inspection to decide the site of anastomosis.

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Colon Interposition for Esophageal Reconstruction in Cancer Patients

International Surgery ◽

10.9738/intsurg-d-17-00119.1 ◽

2018 ◽

Vol 103 (5-6) ◽

pp. 238-247

Author(s):

Martin H. Hangaard ◽

Michael B. Mortensen

Keyword(s):

Cancer Patients ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Colon Interposition ◽

Esophageal Reconstruction ◽

Low Grade ◽

Extensive Review ◽

First Choice ◽

Patient Reported ◽

Esophagectomy For Cancer

Objective: The aim of this study was to report our experience with colon interposition (COI) and to compare the results with an extensive review of the COI literature. Summary of Background Data: The stomach is the first choice as an esophageal substitute following esophagectomy in cancer patients, while COI is reserved for patients where the stomach is not available or must be included in the resection due to cancer. Methods: We retrospectively reviewed the records of cancer patients undergoing colon interposition from 2006 to 2017. Outcomes were compared with an extensive review of the literature published between 2000 and 2017. Results: A total of 13 patients underwent planned COI. Mortality was zero and overall morbidity was 53%; 4 patients suffered from leakage and 2 patients from strictures. None of the patients suffered from necrosis of the interponat and there was no need for subsequent redundancy operations. The extensive review identified 23 publications. Overall study grading was low (grade C). Only 3 studies were prospective, no randomized studies were found, and many outcomes were poorly defined. The rates for 30-day and in-hospital mortality were 1% and 2%, respectively. Overall morbidity was 43%. The reported number of leakages, strictures, necrosis of the interponat, and redundancy operations varied between 0% and 50%, 0% and 21%, 0% and 9%, and 0% and 2%, respectively. Conclusions: COI is a complex technique that is necessary in a relatively small group of selected patients after esophagectomy for cancer. Prospective and comparative studies with strict outcome definitions, long-term follow up, and patient reported outcome measures are lacking.

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