ESOPHAGEAL REPLACEMENT BY COLON INTERPOSITION

Between 1985 and 1993, 32 patients (24 male and 8 female) underwent co lon interposition for replacement of the esophagus at the Mayo Clinic. Median age was 58.5 years (range, 1 to 79 years). The colon was used because of an inadequate stomach in 27 patients (84%) and as the condu it of choice in 5 (16%). Esophageal cancer was present in 15 patients (47%). The left colon was used in 20 patients (63%) and the right, in 12 (38%). The colon was placed substernally in 19 patients (59%) and i n the esophageal bed in 13 (41%). The operative mortality was 9%; caus e of death was ischemic necrosis of right colon conduits in 2 patients and adult respiratory distress syndrome in 1 patient. Major complicat ions occurred in 4 additional patients and included ischemic colitis o f a right colon conduit, Roux-en-Y limb obstruction chylothorax, and a n anastomotic leak. Follow-up was complete for all patients and ranged from 15 months to 7 years (median follow-up, 2.3 years). Eleven patie nts died during follow-up. The cause of death was metastatic esophagea l cancer in 9 patients, myocardial infarction in 1 patient, and respir atory failure in 1 patient. At last follow-up, 26 of the 29 operative survivors had little or no difficulty eating. Two patients had dumping symptoms, and 1 patient had severe dysphagia. Seven patients required dilation of the esophagocolonic anastomosis. We conclude that colon i nterposition for esophageal replacement provides acceptable long-term function; however, early morbidity and mortality are considerable.