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Colonic interposition in esophagectomy: an ACS-NSQIP study

  • 2023 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

For patients with cancer or injury of the esophagus, esophagectomy with reconstruction using the stomach (gastric pull-up, GPU) or colon (colonic interposition, CI) can restore function but is associated with high morbidity. We sought to describe the differences in outcomes between the two replacement organs using a national database.

Methods

From ACS-NSQIP, patients who underwent GPU or CI between 2006 and 2020 were identified. Univariate analyses were performed on length of stay, complications, reoperation, readmission, and mortality. Variables with P ≤ 0.2 were included in the multivariate regression. Primary outcomes were 30-day reoperation, readmission, and mortality. Data were assessed using Chi-squared tests and logistic regression.

Results

There were 12,545 GPU and 502 CI patients. GPU patients were older with higher BMI, and more likely to be male (80.3% versus 70.3%, P < 0.0001) and white (77.8% versus 69.1%, P < 0.0001). More GPU patients had independent functional status and underlying bleeding disorders, but fewer other preoperative comorbidities than CI patients. On univariate analysis, CI patients had longer hospital stays (13 versus 10 days, P < 0.0001); more reoperations (23.9% versus 14.5%, P < 0.0001); a lower rate of discharge to home (70.9% versus 82.1%, P < 0.0001); and a higher mortality rate (6.2% versus 2.9%, P < 0.0001). On multivariate analysis, CI was associated with increased risk of reoperation but not with readmission or mortality. Reoperation was associated with CI, smoking, chronic wound, hypertension, higher ASA class, contaminated or dirty wound class, and longer operative time. Readmission was associated with female gender, hypertension, and longer operative time. Mortality was associated with age, metastatic cancer, preoperative sepsis, preoperative renal failure, malignant esophageal disease, higher ASA class, incomplete closure, and longer operative time.

Conclusion

Colonic interposition, although a more difficult option with traditionally worse outcomes, should still be considered for patients requiring esophagectomy if the stomach cannot be used to restore continuity, as differences in outcomes appear to be due to underlying frailty of patients rather than the procedure.

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Funding

There is no external source of funding for this study.

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Authors and Affiliations

  1. Colorectal Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Ft. Washington Avenue, Floor 8, New York, NY, 10032, USA

    Beatrix Hyemin Choi, James Church & Ravi Pokala Kiran

  2. Thoracic Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Ft. Washington Avenue, Floor 3, New York, NY, 10032, USA

    Joshua Sonett

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  1. Beatrix Hyemin Choi
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Correspondence to Beatrix Hyemin Choi.

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Disclosures

James Church is a consultant for Springworks and Takeda, and has delivered two paid lectures on desmoid disease for Springworks and the Society for Surgical Oncology in the last 36 months. Beatrix Hyemin Choi, Joshua Sonett and Ravi Pokala Kiran have no conflicts of interest or financial ties to disclose.

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Choi, B.H., Church, J., Sonett, J. et al. Colonic interposition in esophagectomy: an ACS-NSQIP study. Surg Endosc 37, 9563–9571 (2023). https://doi.org/10.1007/s00464-023-10420-3

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  • DOI: https://doi.org/10.1007/s00464-023-10420-3

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