Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Surg Today. 2012 Apr;42(4):342-50. doi: 10.1007/s00595-011-0103-7. Epub 2011 Dec 27.
To evaluate the outcomes of colon interposition based on our surgical experience.
We reviewed data from 40 patients who underwent esophagectomy with colon interposition using the terminal ileum and right colon, to treat esophageal cancer, between January 1990 and December 2009.
Transthoracic esophagectomy, transhiatal esophagectomy, and pharyngolaryngoesophagectomy were performed in 31 (77.5%), 8 (20.0%), and 1 (2.5%) patients, respectively. The routes of the colon interposition were posterior mediastinal in 30 (75.0%) patients, retrosternal in 5 (12.5%), and subcutaneous in 5 (12.5%). The median operative time was 450 min (range 320-760 min) and the median blood loss was 755 ml (range 180-3,000 ml). Overall postoperative morbidity involved 18 (45.0%) patients and included esophagoileostomy leakage in 7 (17.5%; minor, n = 4; major, n = 3) and necrosis of the colon conduit in 2 (5%) patients. The 30- and 90-day mortality rates were 0 and 2.5%, respectively. The 1-, 3-, and 5-year survival rates were 80, 66, and 66%, respectively.
Our surgical outcomes were acceptable in relation to other published results and the prognosis was favorable. Thus, esophageal reconstruction using the ileum and right colon is useful for patients with esophageal cancer for whom the stomach is not available. We currently perform colon interposition with microvascular anastomoses for grafts via the subcutaneous route to increase the safety of this operation.
基于我们的手术经验，评估结肠间置术的结果。
我们回顾了 1990 年 1 月至 2009 年 12 月期间，40 例接受末端回肠和右半结肠结肠间置术治疗食管癌的患者数据。
31 例（77.5%）患者接受经胸食管切除术，8 例（20.0%）患者接受经食管裂孔食管切除术，1 例（2.5%）患者接受咽-喉-食管切除术。结肠间置术的途径包括 30 例（75.0%）患者的后纵隔途径、5 例（12.5%）患者的胸骨后途径和 5 例（12.5%）患者的皮下途径。中位手术时间为 450 分钟（范围 320-760 分钟），中位出血量为 755 毫升（范围 180-3000 毫升）。总术后发病率为 18 例（45.0%），包括 7 例（17.5%；轻度 4 例，重度 3 例）吻合口瘘和 2 例（5%）结肠移植物坏死。30 天和 90 天死亡率分别为 0 和 2.5%。1 年、3 年和 5 年生存率分别为 80%、66%和 66%。
与其他已发表的结果相比，我们的手术结果是可以接受的，预后良好。因此，对于无法使用胃的食管癌患者，使用回肠和右半结肠进行食管重建是有用的。我们目前通过皮下途径进行带血管吻合的结肠间置术，以增加该手术的安全性。
