Esophagectomy is one of the most invasive surgical procedures in gastrointestinal surgery. The reconstruction operation is challenging for this group of patients. The surgeon has optional organs for reconstruction such as stomach, colon, and jejunum. Stomach used as a gastric tube or whole stomach is the most prevalent esophageal reconstruction conduit. However, for corrosive ingestion, some patients also have a gastric injury, especially for patients with a high grade of corrosive damage, and the addition of such an unexpected intraoperative situation if gastric conduit is not suitable, makes colon interposition play an essential role.
The colonic interposition could be performed by the left side, right side, and ileocolonic graft as the options for esophagectomy patients (3,19–22). Whatever the reconstruction, the quality of the colon should not be disregarded. Preoperative colonic evaluation is the crucial step in providing intraluminal mucosal information for the surgeon who is responsible for performing reconstruction operations upon this group of patients. The literature reports preoperative investigation for colonic interposition being done by colonoscopy and barium enema (20–22). CT colonoscopy is a minimally invasive technique for colonic screening while avoiding the perforation risk from the colonoscopy procedure and unsuccessful cecal intubation. The concerns around unexpected perforation from colonoscopy if it happens in an esophageal cancer patient, are that not only is patient suffering increased, but the operation might also be delayed and affect the treatment outcome. In addition to complete colonoscopy, especially cecal intubation, it is necessary to gain information for the right side and ileocolonic graft of this operation. In our study, we applied preoperative CT colonoscopy for the patients who were not a high risk of colorectal cancer and the results demonstrated it to be safe and effective for assessing the colon before colonic interposition. Endoscopy was performed in all cases after surgery within three months and could not identify mucosal abnormality of conduit that correlated with the result of preoperative CT colonoscopy.
For postoperative complications, previous studies including a larger number of patients reported anastomosis leakage 3–35%, conduit necrosis 0–9%, anastomotic stricture 6–19%, wound infection 15.8–21%, pulmonary complications 32.6–37% and 30-day mortality 2.1–7.8% (3,19,20,22). Our study had comparable results of leakage and stricture with fewer pulmonary complications. The minor leakage patient was treated conservatively by feeding jejunostomy as nutritional support and closed within two weeks after diagnosis. The leakage patients had become stricture and were handled by balloon dilation. All of the patients with pneumonia were prescribed an intravenous broad-spectrum antibiotic. One patient required respiratory support. We did not find conduit necrosis, surgical site infection, and 30-day mortality in this study. However, any claims to be better or any clear conclusion cannot be made because of the small number of patients.