Colon interposition for esophageal replacement: current indications and long-term function.
BACKGROUND
In contrast to the use of the stomach as an esophageal substitute, the use of the colon is becoming uncommon.


METHODS
From 1985 to 1995, 60 patients underwent colon interposition for esophageal cancer (n = 37), benign stricture (n = 13), iatrogenic fistula (n = 5), achalasia (n = 3), or necrosis of a previous substitute (n = 2). A long isoperistaltic conduit based on the left colonic artery could be used in 52 patients (86.7%). The surgical route used was through the esophageal bed in 38 patients (63.3%), under the sternum in 21 patients, and under the skin in 1 patient.


RESULTS
Colon interposition represented 18.5% of all operations performed for esophageal substitution during the study period. The choice of the colon resulted from an inadequate stomach in 33 cases (55%). The operative mortality rate was 8.3%. Seven patients (13.5%) required dilation of the esophagocolonic anastomosis. At last follow-up, 34 patients (65.4%) had no difficulty eating. Multivariate analysis identified the conduit position in the posterior mediastinum as the sole independent predictor of a good functional result (p = 0.002).


CONCLUSIONS
Colon interposition for esophageal substitution, usually performed when the stomach is not available, provides satisfactory function when placed in the esophageal bed.
Thomas
P
P
Department of Thoracic Surgery, University of Marseille, France.
Fuentes
P
P
Giudicelli
R
R
Reboud
E
E
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001158:Arteries; D003106:Colon / Q000098:blood supply / Q000637:transplantation*; D004106:Dilatation; D004435:Eating; D004931:Esophageal Achalasia / Q000601:surgery; D004937:Esophageal Fistula / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D004940:Esophageal Stenosis / Q000601:surgery; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006085:Graft Survival; D006801:Humans; D007049:Iatrogenic Disease; D008137:Longitudinal Studies; D008297:Male; D008482:Mediastinum / Q000033:anatomy & histology; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D010528:Peristalsis; D012086:Reoperation; D013270:Stomach / Q000637:transplantation; D015996:Survival Rate