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Ann Thorac Surg 2009;88:1647-1653. doi:10.1016/j.athoracsur.2009.05.081
© 2009 The Society of Thoracic Surgeons
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Original Articles: General Thoracic

Colon Interposition After Esophagectomy With Extended Lymphadenectomy for Esophageal Cancer

Shinji Mine, MDa,*, Harushi Udagawa, MD, PhDa, Kenji Tsutsumi, MD, PhDa,b, Yoshihiro Kinoshita, MD, PhDa, Masaki Ueno, MD, PhDa, Kazuhisa Ehara, MDa, Syusuke Haruta, MDa

a Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
b Department of Surgery, Sayama Hospital, Saitama, Japan

Accepted for publication May 27, 2009.

* Address correspondence to Dr Mine, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan (Email: mineshin{at}rc4.so-net.ne.jp).

Background: The purpose of this retrospective study was to investigate the feasibility of colon interposition procedures after esophagectomy with extended lymphadenectomy.

Methods: Between 1990 and 2008, 95 consecutive patients underwent colon interposition after esophagectomy with extended lymphadenectomy for esophageal cancer in our Institution. We reviewed clinical data and long-term survival, and also investigated the association between anastomotic leakage and clinicopathologic findings.

Results: We applied three-field lymphadenectomy to 71 patients and two-field to 24 patients, by a right thoracotomy. Ninety-two patients underwent reconstruction by a retrosternal route, and a posterior mediastinal route was applied to only three patients. We performed hand-sewn anastomosis in the neck in all cases. Three patients required microvascular surgery. Sixty-one patients (64%) experienced postoperative morbidity, most commonly pulmonary complications. Anastomotic leakage occurred in 12 patients (13%). No colon conduit necrosis was detected. Overall mortality, including hospital mortality, was 5.3%. Dysphagia (39%) and diarrhea (38%) were common and stricture was low (6%) after discharge. The overall 5-year survival rate was 43%. During the latter period (1998 to 2008), when ileocolon grafts evolved as the primary choice for interposition, the rate of leakage decreased from 17% (1990 to 1997) to 5.4%. No mortality was recorded during the latter period.

Conclusions: Results from this study demonstrate that colon interposition after esophagectomy with extended lymphadenectomy is feasible and can have a favorable outcome.


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Invited Commentary
Donald E. Low
Ann. Thorac. Surg. 2009 88: 1653-1654. [Extract] [Full Text] [PDF]



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D. E. Low
Invited commentary.
Ann. Thorac. Surg., November 1, 2009; 88(5): 1653 - 1654.
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