Original article
General thoracic
Surgical Outcome of Colon Interposition by the Posterior Mediastinal Route for Thoracic Esophageal Cancer

https://doi.org/10.1016/j.athoracsur.2006.11.049Get rights and content

Background

For thoracic esophageal cancer patients with a history of gastrectomy, esophageal reconstruction using segments of colon was often accomplished using the anterior mediastinal route to avoid fatal complications related to colon necrosis. Our aim was to review our experience with reconstruction by the posterior mediastinal route and assess the surgical outcomes.

Methods

Between 1989 and August 2006, 34 esophageal cancer patients at Akita University Hospital underwent esophageal reconstruction accomplished by colon interposition by the posterior mediastinal route. Data from these patients were reviewed.

Results

Colon conduits consisted of left colon segments in 4 patients and right colon segments in 30. The grafts were supplied with blood by the left colonic artery in 13 patients, the middle colonic artery in 20, and the right colonic artery in 1. The esophagocolic (pharyngocolic) anastomosis was located in the neck in 33 patients (97%) and in the thorax in 1. No patient died during the initial hospital stay. There were no instances of colon necrosis. An anastomotic fistula occurred in 3 patients (9%). Proximal anastomotic strictures occurred in 2 patients (6%). No late graft redundancies resulting in significant dysphagia occurred. Reductions in body weight did not differ from those seen when the gastric tube was used for reconstruction, and alimentary function was good after surgery. The 1-, 2-, 3-, and 5-year survival rates were 66%, 52%, 48%, and 48%, respectively.

Conclusions

Colon interposition by the posterior mediastinal route provides a good outcome and is considered the route of first choice.

Section snippets

Patients and Methods

This retrospective study was reviewed and approved by our Institutional Review Board; individual patient consent was waived. Between 1989 and August 2006, 578 consecutive patients with thoracic esophageal cancer underwent right transthoracic esophagectomy with extensive lymph node dissection at Akita University Hospital. Of the 43 patients (7.4%) who underwent esophageal reconstruction using long-segment colon interposition, 34 (79%) were reconstructed by pulling up the colon by the posterior

Results

The operations took an average of 723 ± 132 minutes, and blood losses averaged 1,056 ± 621 mL (means ± SD). The colon conduits were transposed by the posterior mediastinal route and consisted of left colon segments (transverse-descending colon) in 4 cases and right colon segments in 30 cases (25 ascending-transverse colons, 2 cecum-transverse colons, 3 ileum-transverse colons; Table 3,Fig 1). In only 2 cases, both right colon conduits, was augmentation of the distal arterial supply using a

Comment

We have shown that long-segment colon interposition by the posterior mediastinal route can be performed with no operative mortality and at low risk. In our series, there were no instances of colon necrosis, a 9% incidence of anastomotic leakages, which were cured without surgical treatment, no late redundancy, and good late alimentary function. Thus, colon interposition by the posterior mediastinal route provides good outcomes that compare favorably with esophageal reconstruction by other

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