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Eur J Cardiothorac Surg 2001;20:1063-1064
© 2001 Elsevier Science NL

Letter to the Editor

Intrapleural colon interposition in gastric carcinoma patients

Surgical Department of Thoracoabdominal Oncology, Russian Cancer Research Centre, Kashirsskoe s. 24, Moscow 115478, Russia

Received 10 February 2001; received in revised form 18 May 2001; accepted 12 July 2001.

Corresponding author. Tel.: +7-901-779-2934; fax: +7-095-324-1134
e-mail: ivanstilidi{at}mtu-net.ru

Key Words: Intrapleural colon interposition • Gastric cancer

In patients with recurrent gastric carcinoma and cancer of the cardioesophageal junction, the reconstruction of the removed stomach with a colic segment and intrapleural esophageal anastomosis seemed interesting due to its oncological adequacy and better functionality after the surgery. Colon interposition does not increase postoperative mortality, improves rate of radical resections and quality of life, and significantly reduces the reflux-esophagitis and dumping syndrome rates [2–4]. We investigated intrapleural colon interposition in the surgical treatment of gastric cancer with high esophageal invasion.

In our department cologastroplasty was performed in 16 patients with carcinoma of the upper and middle stomach invading the lower thoracic esophagus and in 8 patients with recurrent tumors following previous surgical treatment of gastric carcinoma. Every patient had an esophagogastroscopy, contrast study, and ultrasound scan of the abdomen and neck. Laparoscopy was performed in 16 patients with primary tumors. The bronchial segment of the esophagus was invaded in two patients, subbronchial in four, retropericardial in 18. Thirteen patients had grade 3 dysphagia, six patients grade 2, and five patients grade 4. At the resection stage through thoracolaparotomy or Lewis approach D2 total or subtotal proximal gastrectomy with lower thoracic esophagus resection was performed; in patients with recurrent tumors, esophago-jejunal anastomosis or gastric remnant extirpation with thoracic esophagus resection were performed. Transverse colon (7), descending colon (16) or ileo-colon segments (1) were used for alimentary tract reconstruction. The choice of this type of plasty was determined by the impossibility of a jejunoplasty. In all of the patients esophagocolic anastomosis was formed manually in the mediastinum by our method: submerged two-row end-to-side anastomosis. The postoperative morbidity rate was 25% and postoperative mortality was 12.5%. There was no case of esophagocolic anastomosis failure. The median follow-up was 16 months. Esophagoscopy; barium swallow; complete blood count; serum biochemistry; and physical examination including assessment of performance status, weight, and swallowing status were done at each visit. Three patients had grade 1–2 and the remaining patients had no dysphagia. Postoperative diarrhea, during the first month, occurred in six patients. No patient reported any reflux symptoms or showed endoscopic findings of reflux esophagitis. The colic graft showed good reservoir function. There were no clinical signs of dumping syndrome. The mean weight of patients at 3 months after operation was 94±1.37% of the preoperative weight.

The creation of a pouch is a important factor in functional terms and gives higher food intake and body weight after gastrectomy [1,5]. In cases of high esophageal invasion we tender the colon interposition. As to placing of the esophagocolonic anastomosis, in the pleural cavity or in the neck, we think that intrapleural colon interposition has some advantages. It requires a shorter graft than for collar anastomosis. On the other hand, collar esophageal anastomoses have a higher rate of postoperative functional disturbances. Meaning that esophageal resection 7–10 cm above the proximal margin of the tumor should be regarded as optimal, we believe that extirpation of thoracic esophagus with collar anastomosis in patients with gastric carcinoma invading the esophagus is not justified oncologically, since the prognosis for these patients depends on the extent of the abdominal and mediastinal lymphadenectomy. We consider that intrapleural colon interposition can be done with acceptable mortality, and it ensures good functional results.

References

1. Lawrence W. Reconstruction after total gastrectomy: what is preferred technique?. J Surg Oncol 1996;63:215-220.[Medline]
2. Metzger J., Degen L., Beglinger C., von Flue M., Harder F. Clinical outcome and quality of life after gastric and distal esophagus replacement with an ileocolon interposition. J Gastrointest Surg 1999;3(4):383-388.[Medline]
3. Hosouchi Y., Nagamachi Y., Hara T. Evaluation of transverse colon interposition following total gastrectomy in patients with gastric carcinoma. Oncol Rep 1998;5(1):87-98.[Medline]
4. Isolauri J., Markkula H., Autio V. Colon interposition in the treatment of carcinoma of the esophagus and gastric cardia. Ann Thorac Surg 1987;43(4):420-424.[Abstract]
5. Buhl K., Lehnert T., Schlag P., Herfarth C., Roder J.D., Eckel F. Reconstruction after gastrectomy and quality of life. World J Surg 1995;19(4):558-564.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Davydov, M. Articles by Bokhyan, V. Search for Related Content PubMed PubMed Citation Articles by Davydov, M. Articles by Bokhyan, V. Related Collections Esophagus - cancer