title: Esophageal reconstruction by colon interposition after esophagectomy for cancer analysis of current indications, operative outcomes, and long-term survival.
abstract: BACKGROUND
  Colon interposition is an alternative solution for esophageal reconstruction if the stomach cannot be used. The study reviews current indications and results of coloplasty for cancer.
  
  
  METHODS
  Patients who underwent colon interposition for gastro-esophageal malignancy were included. Primary coloplasty was defined as upfront colon interposition. Salvage coloplasty was defined as colon interposition after primary reconstruction failure. Mortality, morbidity, function, and survival were evaluated.
  
  
  RESULTS
  We included 28 patients (24 men, median age 61 years). Ten (36%) patients underwent primary coloplasty due to previous gastrectomy (n = 5), conduit gastric cancer (n = 2), extensive gastroesophageal involvement (n = 2), and gastric cancer recurrence (n = 1). Salvage coloplasty was performed in 18 (64%) patients for postoperative graft necrosis (n = 5) and intractable strictures (n = 3). Operative mortality, morbidity, and graft necrosis rates were 14% (4/28), 86% (24/28), and 14% (4/28), respectively; there were no significant differences between primary and salvage coloplasty. Survival rates at 1-, 3-, and 5 years were 81%, 51%, and 38%, respectively. Survival was decreased after primary coloplasty when compared to salvage coloplasty (P = 0.03). Nine patients experienced tumor recurrence (primary: n = 6, salvage: n = 3) after coloplasty and eight of them died.
  
  
  CONCLUSIONS
  Colon interposition after esophagectomy is a useful but morbid endeavor. Colon interposition as salvage therapy is associated with improved survival compared to its use as primary esophageal replacement, and colon interposition in the latter cohort should be used with caution due to poor cancer-specific survival in this patient population.
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Reslinger
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Hadrien
authors.initials: H
authors.lastname: Tranchart
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Elsa
authors.initials: E
authors.lastname: D'Annunzio
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Tigran
authors.initials: T
authors.lastname: Poghosyan
authors.affiliation: Department of Radiotherapy, Saint-Louis Hospital, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Quero
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Corte
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
mesh_terms: D000328:Adult; D000368:Aged; D003106:Colon / Q000637:transplantation*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D010297:Paris; D019651:Plastic Surgery Procedures / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: colon interposition; esophagectomy; gastro-esophageal malignancy; gastroplasty