Effect of Venous Superdrainage on Colon Interposition for Esophageal Reconstruction

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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Dysphagia after Colon Interposition Graft for Esophageal Carcinoma

Case Reports in Pathology ◽

10.1155/2012/738205 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5

Author(s):

C. Spitali ◽

K. De Vogelaere ◽

G. Delvaux

Keyword(s):

Esophageal Carcinoma ◽

Colon Interposition ◽

Barrett Esophagus ◽

Primary Adenocarcinoma ◽

Esophageal Reconstruction ◽

Colonic Interposition ◽

Interposition Graft ◽

Total Esophagectomy ◽

Established Technique

Colon interposition is an established technique for esophageal reconstruction. We describe the case of primary adenocarcinoma arising in a colonic interposition graft that was performed after total esophagectomy for recurrence adenocarcinoma derived from the Barrett esophagus.

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Esophageal reconstruction with colon interposition for corrosive esophageal injury

10.5348/100079z12pv2020cr ◽

2020 ◽

Keyword(s):

Colon Interposition ◽

Esophageal Reconstruction ◽

Esophageal Injury ◽

Corrosive Esophageal Injury

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Clinical Utility of Three-dimensional Computed Tomography for Esophageal Reconstruction using Colon Interposition after Gastrectomy

The Kitakanto Medical Journal ◽

10.2974/kmj.62.143 ◽

2012 ◽

Vol 62 (2) ◽

pp. 143-146

Author(s):

Izumi Takeyoshi ◽

Hiroyuki Toya ◽

Daisuke Yoshinari ◽

Yutaka Sunose ◽

Osamu Totsuka ◽

...

Keyword(s):

Computed Tomography ◽

Clinical Utility ◽

Three Dimensional ◽

Colon Interposition ◽

Esophageal Reconstruction

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Treatment protocol for secondary esophageal reconstruction using ‘supercharged’ colon interposition flaps

Diseases of the Esophagus ◽

10.1093/dote/doaa008 ◽

2020 ◽

Vol 33 (10) ◽

Author(s):

N Esmonde ◽

W Rodan ◽

K R Haisley ◽

N Joslyn ◽

J Carboy ◽

...

Keyword(s):

Care Pathway ◽

Clinical Care ◽

Treatment Protocol ◽

Oral Intake ◽

Gastric Conduit ◽

Colon Interposition ◽

Esophageal Reconstruction ◽

Vascular Pedicle ◽

Secondary Reconstruction ◽

Clinical Care Pathway

Abstract Locoregional esophageal cancer is currently treated with induction chemoradiotherapy, followed by esophagectomy with reconstruction, using a gastric conduit. In cases of conduit failure, patients are temporized with a cervical esophagostomy and enteral nutrition until gastrointestinal continuity can be established. At our institution, we favor reconstruction, using a colon interposition with a ‘supercharged’ accessory vascular pedicle. Consequently, we sought to examine our technique and outcomes for esophageal reconstruction, using this approach. We performed a retrospective review of all patients who underwent esophagectomy at our center between 2008 and 2018. We identified those patients who had a failed gastric conduit and underwent secondary reconstruction. Patient demographics, perioperative details, and clinical outcomes were analyzed after our clinical care pathway was used to manage and prepare patients for a second major reconstructive surgery. Three hundred and eighty eight patients underwent esophagectomy and reconstruction with a gastric conduit. Seven patients (1.8%) suffered gastric conduit loss and underwent a secondary reconstruction using a colon interposition with a ‘supercharged’ vascular pedicle. Mean age was 70.1 (±7.3) years, and six patients were male. The transverse colon was used in four cases (57.1%), left colon in two cases (28.6%), and right colon in one case (14.3%). There were no deaths or loss of the colon interposition at follow-up. Three patients (42.9%) developed an anastomotic leak, which resolved with conservative management. All patients had resumption of oral intake within 30 days. Utilizing a ‘supercharging’ technique for colon interposition may improve the perfusion to the organ and may decrease morbidity. Secondary reconstruction should occur when the patient’s oncologic, physiologic, and psychosocial condition is optimized. Our outcomes and preoperative strategies may provide guidance for those centers treating this complicated patient population.

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