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

Jade Brown, Wyn G. Lewis, Antonio Foliaki, Geoffrey W.B. Clark, Guy R.J.C. Blackshaw, David S.Y. Chan*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1104-1111
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume22
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Keywords

  • Colonic interposition

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