Introduction:
The increase in bariatric surgeries complicate esophagectomies as the stomach is no longer a suitable conduit for reconstruction in many cases.
Objective:
This is a single institutional analysis comparing the outcomes of esophagectomy with colon interposition vs gastric conduit.
Methods:
The data includes 151 patients, who underwent esophagectomy with gastric pull-up vs five patients with colonic conduit reconstruction at a single institution by two high volume surgeons. Transhiatal esophagectomies were performed openly or robotically assisted with cervical anastomosis.
Results:
Patients treated with colon conduit were predominantly female (4/5) compared to 24/151 females in the esophagectomy with gastric pull up group (80 % vs 16%). Mean age was 62 years in both groups. The leak rate from the gastric pull-up group was 12 % with a perioperative mortality rate of 2.7%. No postoperative leak or mortality was noted in the 5 patients with colonic interposition. The length of stay (LOS) varied significantly among patients undergoing esophagectomy with colon conduit (6-89 days, mean 15 days vs mean LOS 12 days for other esophagectomy patients). Two patients with colon conduit experienced a complication Clavien Dindo score of ? III (40%) compared to 39% of patients with gastric conduit. Mean operative time was not significantly different.
Conclusion:
Colon interposition, if performed by experienced surgeons, does not increase complication rate or operative time. Leak rates may be even lower. Nonetheless, LOS appears increased.
Limitations:
This is a single- institution review with limited number of colon interpositions, which could undermine the significance of outcomes examined.
