Effectiveness of Additional Vascular Anastomosis on Colon Interposition in Esophageal Surgery

Takeshi Nagano, Toshiaki Tanaka, Yuichi Tanaka, Satoru Matono, Tatsuji Tsubuku, Kohei Nishimura, Hiromasa Fujita, Kazuo Shirouzu and Yojiro Inoue*

Department of Surgery and Department of Plastic Surgery*, Kurume University School of Medicine

Objective: Anastomotic leakage of the esophagocolostomy is the most serious complication of esophageal surgery using colon interpositioning. We have conducted colon interpositioning for esophageal replacement with a vascular anastomosis since 1989 to overcome this severe complication. Patients: Here we retrospectively review all 86 patients with esophageal disease who underwent colon interpositioning between 1981 and 2007, 77 had esophageal cancer, and 9 benign esophageal disease. We compared the morbidity and mortality between 62 patients who received vascular anastomosis from 1989 to 2007, with the 24 patients who did not receive this from 1981 to 1988. Results: The main postoperative complication was anastomotic leakage. Comparing the incidence rate of anastomotic leakage between patients with vascular anastomosis and patients without it, anastomotic leakage developed less frequently in patients with vascular anastomosis (23%) than in patients without it (63%) (p=0.0003). Anastomotic leakage of esophagocolostomy occurred in 13 (54%) in patients without vascular anastomosis, and 7 of these patients required surgical repair. In patients with vascular anastomosis, leakage of esophagocolostomy occurred in 6 (10%), and all cases healed spontaneously. The postoperative mortality rate was lower in patients with vascular anastomosis (2%) than in patients without vascular anastomosis (17%) (p=0.007). Of 62 patients with vascular anastomosis, 51 underwent supercharge and superdrainage, and 11 underwent superdrainage alone. Anastomotic leakage developed less frequently in patients with the supercharge and superdrainage (6%), than in patients with superdrainage alone (27%) (p=0.03). Conclusions: Our findings suggest vascular anastomosis in colon interpositioning for esophageal surgery gives some advantage, and that the supercharge and superdrainage is more effective than superdrainage alone.

Key words
vasucular anastomosis, esophageal surgery, colon interposition

Reprint requests
Takeshi Nagano Department of Surgery, Kurume University School of Medicine
67 Asahi-machi, Kurume, 830-0011 JAPAN

Accepted
May 27, 2009

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