Operative outcomes and long‐term survival of patients undergoing colon interposition after esophagectomy for cancer

Abstract

Background: The first choice of an esophageal substitute after esophagectomy for cancer is the stomach. However, the colon must be considered for reconstruction in specific situations. The purpose of this study was to clarify the frequency and clinical features of patients who underwent colon interposition in thoracic esophagectomy and to investigate the postoperative complications and survival. Methods: We conducted a retrospective case-control study in the National Cancer Center Hospital East, Japan. Patients who underwent colon interposition after esophagectomy for cancer between 2010 and 2020 were analyzed. Results: Eighty-eight patients underwent esophagectomy with colon interposition; 53.2% received preoperative treatment and 52.3% underwent thoracoscopic surgery. Clavien-Dindo grade >III postoperative complications occurred in 42% of the patients; anastomotic leakage was the most common complication, occurring in 26.1% of the cases. Univariate analysis of the factors associated with Clavien-Dindo grade <III complications showed that the period 2015-2020 and totally mechanical Collard anastomosis were significant factors, with odds ratios (OR) of 0.264 and 0.267 (p = 0.00327 and p = 0.00335), respectively. Totally mechanical Collard anastomosis was associated with a lower risk of anastomotic leakage by univariate and multivariate analysis (OR, 0.257, p = 0.00566 and OR, 0.285, p = 0.133, respectively). Three-year overall survival was 54.2%. Univariate and multivariate analysis of overall survival showed that older age was a risk factor (OR, 1.08) for complications. Conclusion: In colon reconstruction after esophageal cancer resection, totally mechanical Collard anastomosis for cervical anastomosis may reduce the risk of Clavien-Dindo grade >III complications.

Long-Term Outcomes of Colon Conduits in Surgery for Primary Esophageal Cancer: A Propensity Score-Matched Comparison to Gastric Conduits

“…In the present study, the rate of complications associated with colon conduits, including anastomotic leakage, conduit necrosis, and conduit stricture, was 21.6%. This rate is acceptable compared to previous studies [ 7 , 12 , 13 ], but it is significantly higher than the rate for gastric conduits (21.5% versus 3.4%, p<0.001). Regarding anastomotic leakage, when comparing the rate of this complication between cases with thoracic anastomosis and those with cervical anastomosis, colon conduits showed a sharper increase compared to gastric conduits (colon conduit, 9.8%–29.2%; gastric conduit, 2.7%–4.7%).…”

“…In these instances, a colon conduit is generally considered a viable alternative [ 7 - 9 ]. Several retrospective studies have indicated that the use of a colon conduit in esophageal cancer surgery is associated with a relatively poor prognosis (5-year survival rate, 10%–42.2%) and high complication rates (24%–86%) compared to a gastric conduit [ 7 , 10 - 13 ] ( Supplementary Table 1 ). However, most of these outcomes were derived from surgical procedures conducted before the year 2000, meaning that the data do not reflect modern outcomes [ 11 ].…”

“…However, most of these outcomes were derived from surgical procedures conducted before the year 2000, meaning that the data do not reflect modern outcomes [ 11 ]. Furthermore, these studies are limited in that the outcomes of gastric conduit surgery were compared to colon conduits using reference data, rather than comparing to conduits from the same institution during the same period [ 12 , 13 ]. Therefore, it is informative to compare the surgical outcomes of colon conduits in primary esophageal cancer surgery to those of gastric conduits performed during the same period.…”

Distal-continual colon interposition for esophageal reconstruction after esophagectomy: Two case reports

“…Colon interposition refers to the application of the colon as an esophageal graft in esophageal and cardiac cancer surgery (1,2). Colon transplantation is the preferred method after tubular stomach for double primary carcinoma of esophagus and cardia, double primary carcinoma of esophagus and stomach, esophageal cancer after subtotal gastrectomy, and tubular stomach necrosis after replacement (3)(4)(5). Compared to the stomach and jejunum, the colon has regular contraction and can provide sufficient length as a graft (6).…”

“…In most procedures, the transplants are separated from the output colon at the anal side ( 2 ). Complete detachment not only increases the difficulty of the operation, prolonging the operation time but also impairs the neurophysiological function of the colon ( 1 , 5 ). Moreover, the isolated mesentery is prone to torsion wthe transplants are separated from the output colon at the anal side In the Fourth Medical College of Hebei Medical University, colon interposition has become the second choice after radical resection for esophageal cancer, and some modifications were proposed to shorten the operation time and improve the post-surgery prognosis.…”