title: Esophageal replacement by colon interposition with microvascular surgery for patients with thoracic esophageal cancer: the utility of superdrainage.
abstract: Replacing the thoracic esophagus with the colon is one mode of reconstruction after esophagectomy for esophageal cancer. There is, however, a high incidence of postoperative necrosis of the transposed colon. This study evaluated the outcomes of colon interposition with the routine use of superdrainage by microvascular surgery. Twenty-one patients underwent colon interposition from 2004 to 2009. The strategy for colon interposition was to: (i) use the right hemicolon; (ii) reconstruct via the subcutaneous route; (iii) perform a microvascular venous anastomosis for all patients; and (iv) perform a microvascular arterial anastomosis when the arterial blood flow was insufficient. The clinicopathologic features, surgical findings, and outcomes were investigated. The colon was used because of a previous gastrectomy in 18 patients (85.7%) and synchronous gastric cancer in three patients (14.3%). Eight patients (38.1%) underwent preoperative chemoradiotherapy including three (14.3%) treated with definitive chemoradiotherapy. Seven patients (33.3%) underwent microvascular arterial anastomosis to supplement the right colon blood supply. Pneumonia occurred in four patients (19.0%). Anastomotic leakage was observed in five patients (23.8%); however, no colon necrosis was observed. The 3-year and 5-year overall survival rates were both 50.6%. Colon interposition with superdrainage results in successful treatment outcomes. This technique is one option for colon interposition employing the right hemicolon.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan. h-saeki@surg2.med.kyushu-u.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Saeki
authors.forename: M
authors.initials: M
authors.lastname: Morita
authors.forename: N
authors.initials: N
authors.lastname: Harada
authors.forename: A
authors.initials: A
authors.lastname: Egashira
authors.forename: E
authors.initials: E
authors.lastname: Oki
authors.forename: H
authors.initials: H
authors.lastname: Uchiyama
authors.forename: T
authors.initials: T
authors.lastname: Ohga
authors.forename: Y
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Y
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D003106:Colon / Q000098:blood supply / Q000637:transplantation*; D004322:Drainage; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D004947:Esophagus / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007564:Japan; D007601:Jugular Veins / Q000637:transplantation; D008297:Male; D008642:Mesenteric Veins / Q000637:transplantation; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000401:mortality; D012039:Regional Blood Flow; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome