Reslinger Vincent, Tranchart Hadrien, D'Annunzio Elsa, Poghosyan Tigran, Quero Laurent, Munoz-Bongrand Nicolas, Corte Helene, Sarfati Emile, Cattan Pierre, Chirica Mircea
Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
Department of Radiotherapy, Saint-Louis Hospital, Paris, France.
J Surg Oncol. 2016 Feb;113(2):159-64. doi: 10.1002/jso.24118. Epub 2015 Dec 24.
Colon interposition is an alternative solution for esophageal reconstruction if the stomach cannot be used. The study reviews current indications and results of coloplasty for cancer.
Patients who underwent colon interposition for gastro-esophageal malignancy were included. Primary coloplasty was defined as upfront colon interposition. Salvage coloplasty was defined as colon interposition after primary reconstruction failure. Mortality, morbidity, function, and survival were evaluated.
We included 28 patients (24 men, median age 61 years). Ten (36%) patients underwent primary coloplasty due to previous gastrectomy (n = 5), conduit gastric cancer (n = 2), extensive gastroesophageal involvement (n = 2), and gastric cancer recurrence (n = 1). Salvage coloplasty was performed in 18 (64%) patients for postoperative graft necrosis (n = 5) and intractable strictures (n = 3). Operative mortality, morbidity, and graft necrosis rates were 14% (4/28), 86% (24/28), and 14% (4/28), respectively; there were no significant differences between primary and salvage coloplasty. Survival rates at 1-, 3-, and 5 years were 81%, 51%, and 38%, respectively. Survival was decreased after primary coloplasty when compared to salvage coloplasty (P = 0.03). Nine patients experienced tumor recurrence (primary: n = 6, salvage: n = 3) after coloplasty and eight of them died.
Colon interposition after esophagectomy is a useful but morbid endeavor. Colon interposition as salvage therapy is associated with improved survival compared to its use as primary esophageal replacement, and colon interposition in the latter cohort should be used with caution due to poor cancer-specific survival in this patient population.
如果不能使用胃，结肠代食管术是食管重建的一种替代解决方案。本研究回顾了目前结肠癌成形术的适应证和结果。
纳入接受结肠代食管术治疗胃食管恶性肿瘤的患者。初次结肠成形术定义为术前结肠代食管术。挽救性结肠成形术定义为初次重建失败后的结肠代食管术。评估死亡率、发病率、功能和生存率。
我们纳入了28例患者（24例男性，中位年龄61岁）。10例（36%）患者因既往胃切除术（n = 5）、导管胃癌（n = 2）、广泛的胃食管受累（n = 2）和胃癌复发（n = 1）接受了初次结肠成形术。18例（64%）患者因术后移植物坏死（n = 5）和难治性狭窄（n = 3）接受了挽救性结肠成形术。手术死亡率、发病率和移植物坏死率分别为14%（4/28）、86%（24/28）和14%（4/28）；初次和挽救性结肠成形术之间无显著差异。1年、3年和5年生存率分别为81%、51%和38%。与挽救性结肠成形术相比，初次结肠成形术后生存率降低（P = 0.03）。9例患者在结肠成形术后出现肿瘤复发（初次：n = 6，挽救性：n = 3），其中8例死亡。
食管切除术后结肠代食管术是一种有用但有并发症的手术。与作为原发性食管替代物相比，作为挽救性治疗的结肠代食管术与生存率提高相关，并且由于该患者群体中癌症特异性生存率较低，后一组患者应谨慎使用结肠代食管术。
