Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Objective: Although the stomach is the most common organ for esophageal substitution, the colon has to be used whenever the stomach is not available or feasible for some reasons. We presented our experiences in colon interposition for esophageal substitution, with special focus on indication, surgical technique and outcome. Methods: From January 1962 to June 2012, 66 colon interpositions for esophageal substitution were performed in the Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University. There were 41 male and 25 female, with a median age of 21 years (5-77 years). Colon interposition was performed for caustic injury of the esophagus in 38 patients through substernal rout without removal of the esophagus, including one patient with tracheoesophageal fistula formation. Colon interposition was also indicated for 28 patients with malignant esophageal diseases, including 8 patients with cervical esophageal cancer, 7 with esophageal cancer after gastrectomy, 6 patients with multiple cancers in the esophagus and stomach, 6 patients with recurrent cancer at the anastomosis after gastroesophagectomy for cancer, and 1 esophageal cancer patient with failed esophageal substitution with the stomach. For the 28 patients with malignant diseases, colon was mobilized through midline incision of the abdomen, and colon-stomach anastomosis was performed in 24 patients and colon-jejunal loop anastomosis was performed in the remaining 4 patients because of total gastrectomy. Esophagus-colon anastomosis was performed in the thorax in 11 patients, in the neck in 9 patients after resection of the esophagus through thoracotomy. Esophagus-colon anastomosis was performed in the neck after esophageal resection through hiatus without thoracotomy in the 8 patients with cervical esophageal cancer. Results: There was 1 postoperative in-hospital death caused by refractory hypoproteinemia. Anastomotic leakage in the neck occurred in six patients and healed. Severe anastomotic stenosis in the neck occurred in one patients and re-anastomosis was performed 10 months after operation. The median survival time was 25 months for stage I+IIa cancer and 16 months for stage IIb+IIIa disease (X 2 =7.08, P=0.0078). Conclusions: Colon interposition is indicated for the patients with caustic injury of the esophagus, esophageal cancer with the stomach unavailable for esophageal substitution, cervical esophageal cancer for prevention of aspiration pneumonia or suffocation, and esophageal respiratory fistula. The operation is safe and feasible with acceptable mortality and morbidity.

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