Operative Outcomes of Colonic Interposition in the Treatment of Esophageal Cancer: A Three-Decade Experience

Abstract

Background: Colonic interposition is the treatment of choice when the stomach cannot be used as a substitute for reconstruction after esophagectomy for esophageal cancer. The aim of the present study was to review our experience on colonic interposition. Patient and Methods: A prospectively collected database on patients with esophageal cancer from 1982-2010 was reviewed. Outcomes of these patients were analyzed. The indications, morbidity, mortality, long-term survival and potential predictive factors were evaluated. Results: A total of 119 patients were found to have colon harvested for management of esophageal cancer. Of these, 62 had palliative bypass surgery, of which 46 (74.2%) were performed in the 1980s, 16 (25.8%) in the 1990s, and none thereafter. The waning popularity of bypass surgery was probably due to the availability of less invasive palliative modalities such as stenting. For the remaining 57 patients, the median age was 64 (28-82), and 49 (86%) were male. The median blood loss was 850ml (150-2500ml), and the median operative duration was 302 min (150-465min). The reasons for using colonic interposition included: stomach was involved by tumor (n=18 (31.6%)), prior gastrectomy (n=34 (59.6%)), presence of peptic ulcer (n=3 (5.3%)) and others (n=2(3.5%)). There were 4 (7%) patients who had conduit gangrene that required reexploration. Nine (15.8%) patients had either clinical or subclinical anastomotic leakage. The median survival was 34.8 months (17-52 months). The 30-day mortality rate was 3.5% (n=2) and the hospital mortality rate was 15.8% (n=9). Presence of major postoperative medical complications such as stroke or myocardial infarction (p=0.026, HR 2.114, 95%CI 1.094-4.084) was identified to be predictive factors for poor survival. Conclusion: The role of bypass surgery using colon for esophageal cancer management is fading. Colonic interposition remained an important treatment option in patients with prior gastrectomy or when the stomach was invaded by the tumor. The operative procedure was complex and could be associated with high morbidity rate.