Early stage results after oesophageal resection for malignancy - colon interposition vs. gastric pull-up

Objective: The aims of our study were to determine if using the colon as a digestive transplant after oesophagectomy for cancer was associated with in creased postoperative complications, and to assess the impact of preoperati ve radiochemotherapy on postoperative hospital outcome. Methods: From Janua ry 1990 to December 1998, 130 patients underwent oesophageal resection for malignancy. There were 103 males and 27 females (age: 61.3 +/- 11.5 years). Indications were squamous cell carcinoma in 69 patients and adenocarcinoma in 61. Preoperatively 30 patients (eight in stage IIB, 18 in stage III, an d four in stage IV) received radiochemotherapy. There were 84 subtotal oeso phagectomies, with anastomosis in the neck in 44 patients and at the thorac ic inlet in 40, and 46 distal oesophageal resections. Digestive continuity was restored with the stomach in 92 patients (age: 63.4 +/- 10.2 years) and the colon in 38 (age: 52.3 +/- 12.8 years). With the exception of age (P < 0.0001), there was no significant preoperative difference between gastric and colonic groups. Results: Hospital mortality was 8.5% (11 patients), dec reasing from 18.5% (before 1993) to 3.8% (since 1993). One patient (2.5%) d ied in the colonic graft group and ten (11%) in the gastric pull-up group ( P = 0.17). Postoperative complications occurred in 40 patients (31%), respe ctively, in ten (26%) and 30 (33%) patients after colonic and gastric trans plants (P = 0.48), and were pulmonary insufficiency or infection in 29 pati ents, anastomotic fistula in six, myocardial infarction in five, recurrent nerve palsy in four, renal insufficiency in three, and cerebrovascular acci dent in one. All fistulas occurred in the gastric pull-up group. The incide nce of postoperative pulmonary complications was 70% (21/30 patients) in th e subgroup who received preoperative radiochemotherapy, as compared to 11% (5/44 patients) in the subgroup of comparable staging, but without preopera tive treatment (P < 0.001). Conclusions: Colonic grafts are not associated with increased postoperative mortality or complications. Our results sugges t that preoperative neoadjuvant treatment significantly increases postopera tive pulmonary complications. (C) 2000 Elsevier Science B.V. All rights res erved.