Colonic Interposition After Adult Oesophagectomy: Systematic Review and Meta-analysis of Conduit Choice and Outcome

• Published in: Journal of gastrointestinal surgery Vol. 22; no. 6; pp. 1104 - 1111
• Main Authors: Brown, Jade, Lewis, Wyn G., Foliaki, Antonio, Clark, Geoffrey W. B., Blackshaw, Guy R. J. C., Chan, David S. Y.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2018; Springer Nature B.V
• Subjects: Colon - transplantation; Esophageal Neoplasms - surgery; Esophagectomy; Esophagus - surgery; Gastroenterology; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Meta-analysis; Morbidity; Mortality; Review Article; Surgery; Surgically-Created Structures - adverse effects; Systematic review; Transplantation, Autologous - adverse effects; Transplantation, Autologous - methods; Treatment Outcome; Colonic interposition
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-018-3735-8

Background Colonic interposition is a second-line option after oesophagectomy when a gastric neo-oesophagus is not viable. There is no consensus on the optimum anatomical colonic conduit (right or left), or route of placement (posterior mediastinal, retrosternal or subcutaneous). The aim of this review was to determine the optimum site and route of neo-oesophageal conduit after adult oesophagectomy. Methods PubMed, MEDLINE, and the Cochrane Library (January 1985 to January 2017) were systematically searched for studies which reported outcomes following colonic interposition in adults. The outcome measures were overall morbidity and mortality. Results Twenty-seven observational studies involving 1849 patients [1177 males; median age (range) 60.5 (18–84) years] undergoing colonic interposition for malignant ( n  = 697) and benign ( n  = 1152) pathology were analysed. Overall pooled morbidity of left vs. right colonic conduit was 15.7% [95% CI (11.93–19.46), p  < 0.001] and 18.7% [95% CI (15.58–21.82), p  < 0.001] respectively. Overall pooled mortality of left vs. right colonic conduit was 6.5% [95% CI (4.55–8.51), p  < 0.001] and 10.1% [95% CI (7.35–12.82), p  < 0.001] respectively. Retrosternal route placement was associated with the lowest overall pooled morbidity and mortality of 9.2% [95% CI (6.48–11.99), p  < 0.001] and 4.8% [95% CI (3.74–5.89), p  < 0.001] respectively. Conclusion Left colonic conduits placed retrosternally were safest.