Colonic Intramucosal Cancer in the Interposed Colon Treated with Endoscopic Mucosal Resection: A Case Report and Review of Literature

Colon interposition is a surgical procedure used for maintenance of luminal conduit after esophagectomy. Although epithelial neoplasia, such as adenoma and adenocarcinoma, may develop in the interposed colon, there are only few case reports on the condition. Due to the rarity of this condition, there is no definite consensus on recommending screening endoscopy for the early detection of neoplasia in the interposed colons. Here, we report a case of intramucosal adenocarcinoma in an interposed colon. Initial endoscopic resection for this tumor failed to accomplish complete resection. A subsequent endoscopic resection was performed 1 month later and complete resection was achieved. Based on our experience and recommendation on screening endoscopy for gastric cancer in Korea, we suggest that regular screening esophagogastroduodenoscopies should be performed following esophagectomy to detect early neoplasia in the stomach and interposed colon and avoid adverse results induced by delayed detection.

Faringo-íleo-colo anastomosis con suplemento vascular microquirúrgico en reconstrucción del tracto digestivo superior / Pharyngo-ileo-colo-anastomosis with micro-vascular blood supply augmentation for surgical reconstruction of the upper digestive tract

Resumen Introducción Los pacientes sometidos a desconexión total con cierre al nivel del seno piriforme debido a necrosis completa del esófago y estómago después de la ingestión cáustica representan un desafío quirúrgico para restablecer la ingestión oral y la calidad de vida. Objetivo El objetivo de este trabajo es presentar la experiencia con un caso clínico con necrosis total de esófago y estómago posingestión de cáuticos por lo que fue inicialmente sometido a esofagectomía y gastrectomía total. Método La reconstrucción del tracto digestivo superior se efectuó mediante una faringo-íleo-colo anastomosis, con suplemento de irrigación sanguínea arterial y drenaje venoso mediante técnica de anastomosis microquirúrgica. Resultados No se observaron complicaciones postoperatorias mayores y en el resultado a largo plazo se logra alimentación oral normal con una recuperación nutricional adecuada y buena calidad de vida. Conclusión Esta es un procedimiento a plantear en pacientes con estenosis faríngea sin posibilidad de reemplazo esofágico con procedimientos menos complejos.

Introduction Patients submitted to total esophagectomy and gastrectomy with complete closure of pharinx due to necrosis after caustic ingestion are a challenging surgical setting for reconstruction of upper digestive transit. Objective The objective of this paper is to present a clinical case and surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy. Method Reconstruction of digestive transit was reestablished by means of a pharyngo-ileo-colonic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Results There were not major postoperative complications and at long term follow-up, normal oral nutrition and quality of life improvement was observed. Conclusion This is a surgical procedure for treatment of patients with pharyngeal strictures without any possibility to indicate other less complex procedures.

Improvement to colon interposition after esophagectomy / 中华胸心血管外科杂志

Objective To explore the improving safety measures of colon interposition after esophagectomy .Methods From January 2003 to December 2014, 65 cases of colon interposition after esophagectomy were performed, and some improve-ments were made in the methods and procedures .Mainly including: Preoperative evaluation to first operation; Selection of co-lon segment; Simplify vascular anatomy;Cervical anastomosis was replaced by intrathoracic anastomosis;Modified anastomosis sequence; Strengthen preoperative preparation.Results There were no perioperative deaths.Only 2 patients with cervical fis-tula, due to malnutrition automatically discharged.The rate of anastomotic leakage on neck were 27.77%(10/36) and 6.89%(2/29) in the chest.2 cases were completed intestinal obstruction after jejunostomy , 1 cases of volvulus and 1 cases of intus-susception confirmed by reoperation.Conclusion Colon interposition after esophagectomy is a very important way of surgery. The operation process is complex, but as long as mastering the point of surgery, improving the surgical procedures, the good effect can be obtained and greatly improve the safety of the operation .

Reconstitución de tránsito esofágico con interposición de colon derecho / Esophageal reconstruction using right colon interposition

Background: Esophageal replacement therapy is indicated for benign and malignant esophageal lesions and can be performed using stomach, jejunum or colon. Aim: To report the experience using right colon interposition for esophageal replacement. Material and Methods: Review of medical records of 41 patients aged 17 to 73 years (29 males), subjected to right colon interposition in the last 20 years. Indications, complications, mortality and long term results were recorded. Results: Forty nine percent of patients had a malignant esophageal lesion. Esophagectomy was performed using a transhiatal route or thoracotomy in 44 and 30 percent of patients, respectively. Retroesternal ascension was the most common route used in 88 percent of patients. The most common surgical complication was cervical fistula in 29 percent of patients, followed by fistula of the anastomosis between colon and jejunum in 7 percent of patients. Pneumonia was the most common medical complication. Postoperative mortality was 7 percent. Conclusions: The mortality in this series of patients is similar to that reported elsewhere.

Introducción: La cirugía de reemplazo esofágico actualmente se indica para tratamiento de enfermedades benignas y malignas del esófago. Existen diversas técnicas de reconstitución de tránsito esofágico que utilizan estómago, yeyuno o colon. Objetivo: Presentar la experiencia acumulada en el Hospital Clínico de la Universidad de Chile utilizando la técnica de transposición de colon derecho para la reconstitución de tránsito esofágico. Materiales y Métodos: Estudio descriptivo restrospectivo que incluyó a los pacientes sometidos a reconstitución de tránsito esofágico mediante interposición de colon derecho, durante los últimos 20 años, basado en la revisión sistemática de historias clínicas, analizando causas, morbilidad precoz y tardía, mortalidad operatoria, compararándolos con los resultados de la literatura. Resultados: Se incluyen 41 pacientes operados, con edad promedio de 63,6 años (17-73), 29 de ellos de sexo masculino (70,7 por ciento). El 48,7 por ciento correspondieron a neoplasias malignas, el resto a patología benigna. En 43,9 por ciento la esofaguectomía se realizó por vía transhiatal y 29,7 por ciento por toracotomía. El ascenso retrosternal fue la vía más empleada (87,8 por ciento). La complicación más frecuente correspondió a la fístula cervical en 29,3 por ciento seguida de la fistula en colo-yeyuno anastomosis en el 7,3 por ciento de los casos. La neumonía fue la complicación médica más frecuente (14,7 por ciento). La mortalidad postoperatoria fue 7,3 por ciento. Conclusión: El uso de interposición de colon derecho tiene indicaciones precisas. La mortalidad operatoria reportada se ajusta a lo encontrado en la literatura internacional.

Colon Interposition via the Retrosternal Approach without Enlargement of the Thoracic Inlet for the Management of Esophageal Stricture / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To report our experience of colon interposition without thoracic inlet widening for the management of esophageal stricture. SUBJECTS AND METHOD: Between 2005 and 2012, five patients underwent esophageal replacement using colon graft. Clinical data, such as surgical techniques including thoracic inlet widening, surgical outcomes, and patient's age and gender were retrospectively analyzed. The follow-up period ranged from 10 months to 5 years. RESULTS: All five patients had corrosive esophageal stricture and underwent colon interposition without thoracic inlet widening; four underwent pharyngocologastrostomy and one total laryngopharyngectomy and pharyngocologastrostomy. No major complications, such as aspiration, dysphagia, reflux, or swallowing disorder developed during the postoperative long term follow-up. CONCLUSION: A colon graft without enlargement of the thoracic inlet is an excellent esophageal substitute for patients with an esophageal corrosive stricture. Further surgical experience and more long-term follow-up data are required to produce more precise and statistically meaningful results.

Colon Interposition into Hypopharynx in a Patient with Corrosive Esophageal Stricture / 대한이비인후과학회지

A 68-year-old male visited the hospital presenting swallowing difficulty that persisted for 30 years. In the military service, the patient accidentally ingested glacial acetic acid and esophageal obstruction was developed. Transverse and left colon was used for reconstruction for esophagus. The colon was pulled up via substernal route and anastomosed to pyriform sinus proximally and body of stomach distally. Partial resection of the manubrium and clavicular head was performed to avoid interference with the passage of the esophageal substitute. There was no operative complication except vocal cord palsy. Under fluoroscopy, the swallowing time of barium from the pharynx to the level of the diaphragm was 4 to 6 seconds. The patient could swallow solid food without aspiration, obstruction, or significant regurgitation 2.5 months after the surgery.

Surgical Option for Sufficient Safety Margine in Locally Advanced Type II Cardia Cancer-Left Colon Interposition

PURPOSE: Radical surgery is the standard therapy for patients with resectable cardia cancer. In the case of type II disease with esophageal invasion, a transhiatal extended radical total gastrectomy is needed or a gastroesophagectomy through an abdomino-thoracotomy, depending on the extent of the esophageal invasion. We analyzed the indications and outcome of left colon interposition as an esophageal substitution. MATERIALS AND METHODS: Between 1 January 1994 and 31 December 2006, 10 patients underwent left colon interposition after gastroesophagectomy through an abdomino-thoracotomy or the tanshiatal approach for type II cardia cancer at the Department of surgery, Yonsei University College of Medicine. The outcomes of these patients were reviewed and compared, with those who underwent a Roux-en-Y, by gender and age matched analysis, retrospectively. RESULTS: There were nine males and one female with a mean age of 52.5 (range, 16~72). The operation time was 449.00+/-87.39 minutes. The mean distance between the proximal resection margin and the cancer was 6.56+/-3.65 cm; the maximum size of the tumor was 9.90+/-3.97 cm. These measures differed significantly from patients who underwent Roux-en-Y. The patients had a double primary cancer in the cardia and esophagus. There were no events of colon necrosis. However, a pneumothorax occurred in one patient (10%) and a proximal anastomotic stricture occurred in one patient. There were no reports of heartburn, regurgitation, thoracic or epigastric fullness, and one patient even gained weight, 16 kg. CONCLUSION: Colon interposition after esophagogastrectomy was safe and effective and should be considered as an additional surgical option for locally advanced type II cardia cancer patients with esophageal invasion.

Colon Interposition as a Gastric Substitute after Performing Gastrectomy in Patients with Gastric Cancer

PURPOSE: For most surgeons, colon interposition after gastrectomy remains an infrequently performed procedure because of its complexity. The aim of this study was to assess its technical feasibility and safety as a post-gastrectomy reconstruction method by reviewing our experience with colon interposition. MATERIALS AND METHODS: From March 2001 to February 2002, 30 colon interpositions after- gastrectomy were done with using the ileo-ascending or transverse colon. We analyzed the clinicopathologic features and the surgical outcomes. RESULTS: There were 16 males and 14 females in this study with a mean age of 67.5 years (range: 31 to 76 years). Twenty-five ascending colons and 5 transverse colons were used for the interposition, respectively. The mean operation time was 373 minutes (range: 204 to 600 minutes). There were 9 operative morbidities (30%) and 1 operative mortality. The restoration of bowel motility was noted at 3.8 postoperative days; a soft diet was started at 4.9 postoperative days and the duration of the hospital stay was 18.2 days. The percentage of weight loss in the patients with total, proximal and distal gastrectomy was 16.3%, 14.0% and 8.8%, respectively, at 6 months, and thereafter the weight loss gradually recovered as 8.1%, 7.5% and 5.6%, respectively, at 5 years postoperatively. Gastric stasis was the one of the most meaningful long-term complications, and especially in the patients who underwent distal gastrectomy with colon interposition. CONCLUSION: Colon interposition after gastrectomy was a very complex procedure with a long operating time and many anastomosis sites. The postoperative outcomes failed to achieve satisfactory weight gain and the patients displayed postprandial symptoms. This suggested that this procedure was not an appropriate procedure for conventional reconstruction after gastrectomy.

A Case of More Abundant and Dysplastic Adenomas in the Interposed Colon than in the Native Colon

We report a 60-year-old woman with intramucosal adenocarcinoma arising in the interposed colon, 40 years after the esophageal reconstruction for lye induced esophageal stricture. Although synchronous adenomas were also found in the native colon where the graft was taken, the number of adenomas was greater in the interposed colon and more dysplastic, even progressed to adenocarcinoma, than that of the native colon. The microsatellite instability-testing performed in the intramucosal carcinoma from interposed colon showed absence of microsatellite instability. Changing of location and functional deman]d of colonic segment, and the exposure to different intraluminal contents might have facilitated the adenoma- carcinoma transformation in the interposed colon.

Colon Interposition after Radical Total Pharyngolaryngoesophagectomy in a Patient with Subtotal Gastrectomy

The principle treatment for cervical esophageal cancer and hypopharyngeal cancer with esophageal invasion is radical total pharyngolaryngoesophagectomy (PLE), and it is necessary to totally reconstruct the defect of the resected organ. Stomach, small bowel, colon, a laryngotracheal flap and a pectoralis major musculocutaneous flap can all be used. We commonly use stomach because stomach has a rich blood supply and a low incidence of leakage. But in this present reported case, because previous radical subtotal gastrectomy with gastrojejunostomy had been done, we had to use colon for reconstruction. We use the left colon and left colic artery, and there were no complications. We report here on using the left colon and left colic artery to reconstruct a PLE defect for the first time in Korea.