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COLON INTERPOSITION AFTER ESOPHAGECTOMY: A 15-YEARS SINGLE-CENTER EXPERIENCE
Luca Giulini*1, Melissa Kemeter1, Lisa Bernhardt1, Lucas Thumfart1, Patrick Heger1, Felix J. Hüttner1, Markus K. Diener1, Attila Dubecz2
1Klinikum Nurnberg, Nuremberg, BY, Germany; 2HELIOS Klinikum Erfurt, Erfurt, Thuringia, Germany

Background: Colonic interposition is the treatment of choice for alimentary tract reconstruction when a gastric conduit pull- up is not possible. Aim of this study was to analyze perioperative outcomes of patients who underwent colonic interposition for different indications in our tertiary-care center over 15 years.

Methods: After IRB-Approval, all patients who underwent colonic interposition for esophageal replacement were identified from our prospectively maintained institutional database. A chart review was performed and perioperative variables were analyzed and reported with descriptive statistics.

Results: In total, 93 consecutive patients (62 men and 31 women, median age 65 years) who were treated between January 2009 and December 2023 were identified. Indication was benign disease in 17.2% and malignancy in 82.8% of the cases. Most commonly (96.8%) a hand-sewn cervical anastomosis was performed. The left colic artery based colonic graft was pulled-up either through the posterior mediastinum (52.7%) or retrosternal (46.3%). Median operative time was 303 minutes (range 146 to 592 min). Most common surgical complications were anastomotic leakage (26.9%), bleeding (10.8%), pleural empyema (11.8%) and anastomotic stenosis (30.1%). Reoperation rate was 36.6%. In-hospital mortality rate was 18.3%. Median hospital stay was 28 days (range 2 to 137 days).

Conclusion: Colon interposition after esophagectomy represents a very invasive and technically challenging operation with high morbidity and mortality rates. Therefore, this option for alimentary tract reconstruction should only be performed in experienced high-volume centers and reserved to accurately selected patients.
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