TY - JOUR
T1 - Colonic Interposition After Adult Oesophagectomy
T2 - Systematic Review and Meta-analysis of Conduit Choice and Outcome
AU - Brown, Jade
AU - Lewis, Wyn G.
AU - Foliaki, Antonio
AU - Clark, Geoffrey W.B.
AU - Blackshaw, Guy R.J.C.
AU - Chan, David S.Y.
N1 - Publisher Copyright:
© 2018, The Society for Surgery of the Alimentary Tract.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - 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.
AB - 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.
KW - Colonic interposition
UR - http://www.scopus.com/inward/record.url?scp=85043370228&partnerID=8YFLogxK
U2 - 10.1007/s11605-018-3735-8
DO - 10.1007/s11605-018-3735-8
M3 - Review article
C2 - 29520647
AN - SCOPUS:85043370228
SN - 1091-255X
VL - 22
SP - 1104
EP - 1111
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 6
ER -