636. EVOLUTION OF THE INDICATION OF COLONIC INTERPOSITION FOR THE ESOPHAGUS - THE PAST AND THE PRESENT

Abstract

Abstract Although the stomach is the most common organ used for reconstruction after esophagectomy, some situations precluded its use. The colon is a common alternative. The outcomes of colonic interposition from previous literature were very variable. Our study aims at reviewing the evolution in the indications and outcomes of colonic interposition over the past 38 years. This is a retrospective cohort study of all patients who underwent colonic interposition from November 1982 to October 2021 at our centre. Primary outcomes included 30- and 90-day mortality. Secondary outcomes include surgical complications including anastomotic leakage, anastomotic stricture and graft ischaemia. The major indication of colonic interposition shifted from palliation of esophageal cancer to substitute conduit for curative esophagectomy in the study period. Its use was also extended to the treatment of caustic esophageal injuries in recent years. In terms of surgical techniques, there were significantly higher rates of the retrosternal route of reconstruction and more use of the right colon in recent years. In patients who underwent colonic interposition after curative esophagectomy for esophageal cancer, the 30- and 90-day mortality were 1.9% and 5.7% respectively. The occurrence of anastomotic leakage, stricture and graft ischaemia were 9.6%, 17.3% and 7.7% respectively. Colonic interposition represents a viable option when the stomach cannot be used to replace the diseased esophagus. Despite its complexity, we demonstrated reasonable survival and comparable outcomes of the technique.