Does the interponat affect outcome after esophagectomy for cancer?

Clinical decision-making in esophageal cancer surgery is a process of balan cing the risks of treatment against potential benefits, such as survival an d quality of life. Various options are available for esophageal reconstruct ion. While these reconstructive options do not directly have an impact on c ancer survival, they do affect operative morbidity and long-term quality of life. The affect of various interponats (reconstructive conduits) and rout es of reconstruction on operative morbidity and foregut function is reviewe d. Gastric interponats are preferred for esophageal reconstruction because of their reliable vascularity and the relative simplicity of the reconstruc tive operation. Colon interponats supposedly provide better long-term funct ion as an esophageal substitute (unproven), but at the cost of increased op erative complexity and morbidity. Colon interposition is therefore reserved for situations in which gastric transposition is not feasible. Both poster ior and anterior mediastinal routes of gastric interponat reconstruction ar e acceptable (meta-analysis of randomized controlled trials). Posterior med iastinal reconstruction is usually preferred when a complete (R0) resection has been accomplished. Anterior mediastinal reconstruction may prevent sec ondary dysphagia after incomplete (R1, R2) resections.