German experience with colon interposition grafting as an esophageal substitute^*

Abstract

Preliminary results of a questionnaire survey showed that gastric transposition is the technique of choice in Germany to restore alimentary continuity after esophageal resection. Experience with colon interposition grafting is low. Only 13% of all centers perform this technique. Despite this limited experience, there appears to be no difference in the complication rate between gastric pull-through procedures and colon interpositions. A modification of established colon interposition techniques is possible when the right colon is used if it is prepared in such a way that the left colonic artery is the blood supplying vessel. This modified technique may be simpler to perform than previous procedures for creating a colon interposition graft and may also facilitate esophageal replacement using colon interposition grafting.

Interposición de colon transverso como alternativa de reconstrucción tras la esofagogastrectomía total

“…En relación al primer punto, la circulación del ciego, la cual deriva de los vasos ileocolocecoapendiculares no es siempre constante y su colateralidad depende en su mayor porcentaje de la arteria y vena ileocoloapendicular (la cual debe ser seccionada) y no así de la arcada marginal 9,16 . Además en un 20% la cólica derecha está ausente y en un 5% no existe una anastomosis entre la cólica derecha y la ileocólica, lo cual hace que la coloplastía derecha tenga más riesgo por lo menos teórico de isquemia.…”

“…Sin embargo, según varios autores, la probabilidad de que esto ocurra es de un 0-10%, similar a las otras coloplastías 16,18,19 . Es más, un grupo alemán de alta experiencia en reconstrucción del tránsito esofágico muestra 0% de necrosis del injerto ascendiendo de colon derecho en base al pedículo de la arteria cólica izquierda 9,16 .…”

Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?

“…Postoperative complications vary from 41 to 67% in the contemporary literature, mainly the pneumonia, pleural effusion and fistulas In fact, cervical anastomosis fistulas are from 5.8 to 46% of the cases 5,8,12,17,19,21,24 . Despite the frequency of this complication, treatment with oral fasting or soft diet associated with cervical drainage is resolving most of the time.…”

“…In fact, only a few specialized services perform this procedure. German authors Table 2 -Table 2 -Table 2 -Table 2 -Table 2 8,9 . In published series of esophageal resection, total esofagogastrectomy represent no more than 10% of the procedures 5,12,13 .…”

“…The indications of total esophagogastrectomy are limited to certain conditions, particularly in radical resection of large tumors of the esophagogastric junction (EGJ) invading both viscera, esophageal tumors in patients with previous gastrectomy, severe caustic esophageal lesions with irreversible loss and stomach and congenital esophageal atresia 7 . Therefore, considering the rarity of conditions that require total esophagogastrectomy, such procedure is the absolute minority of resection surgeries performed in the esophagus and / or stomach, and few institutions had experience with this type of operation [8][9][10][11] . The aim of this study is t t t t to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction.…”