Frequency of Polyps and Adenocarcinoma in Colon Interposition After Esophagectomy in Adulthood – A Systematic Review

Abstract

Background/Aim: Colon interposition counts among the most common techniques for reconstruction after esophagectomy. Availability of data on metachronous mucosal pathologies is weak. The aim of this review was to identify all reports on the development of metachronous adenoma and adenocarcinoma in colon interposition after esophagectomy in adulthood. Materials and Methods: A comprehensive search was conducted in MEDLINE/PubMed, Science Direct, Cochrane Library, Bayerische Staatsbibliothek München. All studies reporting on patients who received colon interposition as substitute after esophagectomy in adulthood for benign and malignant reasons were included. Results: Five retrospective studies were included, reporting on 1016 patients. Therein, no interval lesion was identified. One further study, which formally must be excluded for a misfit to inclusion criteria reports on three interval carcinomas within 365 patients. Because these lesions were the only ones found within a cohort analysis, results were supplementary reported in this review. Additionally, 31 case reports including 32 patients with benign (n=7) or malignant (n=25) findings were analyzed. Median age was 63.5 years (interval carcinoma) and 69 years (benign lesion). Benign and malignant lesions were diagnosed after a median of 8.5 years. Conclusion: Due to the rareness of respective cohort studies, the frequency of metachronous lesions cannot be calculated accurately. The estimated rate of interval carcinoma is 0-0.22%. Life-long endoscopic surveillance of patients with colon interposition is recommended.Esophagectomy with replacement by colon interposition was first described by Kelling and Vuillet in 1911 (1, 2). Since then, the colon developed into the most commonly used esophageal substitute if the stomach is not available for reconstruction (3). The majority of patients undergoing esophagectomy with colon interposition for malignant disease are older than 55 years and thereby at risk for the development of colonic polyps. Further, patients with adenocarcinoma of the esophagus showed a significantly higher risk for the occurrence of colonic polyps (4). Patients, who receive the interposition procedure for benign pathologies are relevantly younger in common, therefore their lifetime risk for the development of mucosal changes in the substitute is relatively higher. To date, no systematic review focuses on the rate of mucosal changes such as adenoma and adenocarcinoma in colon interposition in adulthood.

Beware of gastric tube in esophagectomy after gastric radiotherapy: A case report

“…Colonic interposition is complicated by the need for three to four anastomoses and potential metachronous development of adenoma and carcinoma. Nevertheless, longer grafts are available offering reservoir-like function and less reflux[ 4 , 5 ]. However, a retrospective cohort study comparing complex esophageal reconstruction including 44.7% of patients with other than gastric tube formation to non-complex esophagectomy with direct gastric pull-up reported higher morbidity and longer length of stay for patients in the complex therapy group[ 6 ].…”

Colonic interposition graft and risk of adenomatous polyp. Do we need screening?

“…Histopathologic evaluation revealed tubular adenoma with high-grade dysplasia and tubular adenoma with low-grade dysplasia respectively. 1 2 3…”