RT Journal
A1 Davis PA, Law S, Wong J
T1 COlonic interposition after esophagectomy for cancer
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD March 1
VO 138
IS 3
SP 303
OP 308
DO 10.1001/archsurg.138.3.303
UL http://dx.doi.org/10.1001/archsurg.138.3.303
AB 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&lt;.001) and longer operation duration (median, 270 vs 225 minutes; P&lt;.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 intra-abdominal septic complications (9.5% vs 0.2%; P&lt;.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&gt;.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.