COLON INTERPOSITION FOR ESOPHAGEAL REPLACEMENT - CURRENT INDICATIONS AND LONG-TERM FUNCTION

Background. In contrast to the use of the stomach as an esophageal sub stitute, the use of the colon is becoming uncommon. Methods. From 1985 to 1995, 60 patients underwent colon interposition for esophageal can cer (n = 37), benign stricture (n = 13), iatrogenic fistula (n = 5), a chalasia (n = 3), or necrosis of a previous substitute (n = 2). A long isoperistaltic conduit based on the left colonic artery could be used in 52 patients (86.7%). The surgical route used was through the esoph ageal bed in 38 patients (63.3%), under the sternum in 21 patients, an d under the skin in 1 patient.Results. Colon interposition represented 18.5% of all operations performed for esophageal substitution during the study period. The choice of the colon resulted from an inadequate stomach in 33 cases (55%). The operative mortality rate was 8.3%. Seve n patients (13.5%) required dilation of the esophagocolonic anastomosi s. At last follow-up, 34 patients (65.4%) had no difficulty eating. Mu ltivariate analysis identified the conduit position in the posterior m ediastinum as the sole independent predictor of a good functional resu lt (p = 0.002). Conclusions. Colon interposition for esophageal substi tution, usually performed when the stomach is not available, provides satisfactory function when placed in the esophageal bed. (C) 1997 by T he Society of Thoracic Surgeons.