Extended left colon interposition for pharyngoesophageal reconstruction using distal-end arterial enhancement

In pharyngoesophageal reconstruction with colon interposition, the oral segment of colon graft suffers from high incidence of ischemia necrosis. This leads to increased rate of fistula formation and hence increased mortality. This study described an arterial enhancement procedure for uncomplicated colon interposition. Five patients who had undergone pharyngoesophageal reconstruction with extended left colon interposition were reviewed, all of whom had advanced hypopharyngeal cancer with cervical esophagus invasion. Insufficient blood supply of the distal colon was noted following pharyngocolostomy. Arterial enhancement from the distal end of the sigmoid artery branch to the superior thyroid artery (four cases) or facial artery (one case) was performed. All patients displayed good circulation and peristalsis of colon interposition graft perioperatively. The pharyngocolostomy junction was free of leakage and colon graft necrosis. Barium study revealed a wide patent anastomosis postoperatively. Patients tolerated regular diet without problems following discharge. This demonstrated distal arterial enhancement procedure during extended colon interposition is a feasible technique for preventing serious complications for pharyngoesophageal reconstruction.