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Background
Colonic interposition is the treatment of choice when the stomach cannot be used as a substitute for reconstruction after esophagectomy for esophageal cancer. The aim of present study was to review our experience on colonic interposition.
Patient and Methods
A prospectively collected database on patients with esophageal cancer from 1982-2010 was reviewed. Outcomes of these patients were analyzed. The indications, morbidity, mortality, long-term survival and potential predictive factors were evaluated.
Results
A total of 119 patients were found to have colon harvested for management of esophageal cancer. Of whom, 62 had palliative bypass surgery and 46(74.2%) were performed in 80s, 16 (25.8%) in 90s, and none in 00s. The role of bypass surgery become less popular was probably due to the availability of less invasive palliative modalities such as stenting. For the remaining 57 patients, the median age was 64 (28-82) and 49 (86%) were male. The median blood loss was 850ml (150-2500ml), and the median operative duration was 302 min (150-465min). The operative procedures and route of reconstruction of these 57 patients were listed in table 1 and 2 respectively. The reasons of using colonic interposition included: stomach was involved by tumor (n=18 (31.6%)), prior gastrectomy (n=34 (59.6%)), presence of peptic ulcer (n=3 (5.3%)) and other (n=2 (3.5%)). There were 6 (10.5%) had conduit gangrene required re-exploration. Nine (15.8%) patients had either clinical or subclinical anastomotic leakage. The median survival was 34.8 months (17-52 months). The 30-day mortality rate was 3.5% (n=2) and the hospital mortality rate was 15.8% (n=9). Presence of major post-operative medical complications such as stroke or myocardial infarction (p=0.026, HR 2.114, 95%CI 1.094-4.084) was identified to be predictive factor for poor survival.
Conclusions
The role of bypass surgery using colon for esophageal cancer management is fading. Colonic interposition remained an important treatment option in patients with prior gastrectomy or when the stomach was invaded by the tumor. The operative procedure was complex and could associated with high morbidity rate.

Table 1. Operative procedures of 57 patients had colonic interposition in esophagectomy for esophageal cancer with curative intent

Procedures	N=57(100%)
Pharyngolaryngoesophagectomy	5 (8.8)
Transhiatal	9 (15.8)
Minimally invasive esophagectomy	2 (3.5)
3 phase esophagectomy	13 (22.8)
Lewis Tanner esophagectomy	18 (31.6)
Staged	5 (8.8)
Other	5 (8.8)

Table 2. Route of reconstruction of 57 patients who had colonic interposition in esophagectomy for esophageal cancer with curative intent

Route of reconstruction	N=57(100%)
Subcutaneous	3 (5.3)
Retrosternal	19 (33.3)
Right chest	6 (10.5)
Orthotopic	29 (50.9)