Long-term quality of life and alimentary satisfaction after esophagectomy with colon interposition

The long-term outcome after colon interposition for esophageal reconstruction is not well documented. Our objective was to assess quality of life and alimentary satisfaction 10 or more years after colon interposition.

Patients who had an esophagectomy that was reconstructed using a colon interposition before April 2003 were identified. Symptoms, alimentary satisfaction, and quality of life were assessed by telephone interview and questionnaires.

We identified 79 surviving patients, and follow-up was obtained in 63 (80%). The indication for esophagectomy was cancer in 45 patients and benign disease in 18. Vagal-sparing esophagectomy was performed in 48% of patients, en bloc in 44%, and transhiatal in 8%. Median follow-up was 13 years (range, 10 to 38 years). The median Gastrointestinal Quality of Life Index score was 3 of 4 and results from the RAND 36-Item Short Form Health Survey (RAND Corp, Santa Monica, CA) were at or above the published normal means in all categories. Most patients were free of dysphagia (89%), regurgitation (84%), and heartburn (84%). The most common postprandial symptom was early satiety (40%). The body mass index was within normal reference ranges in 90% of patients. Follow-up esophagogastroduodenoscopy in 30 patients at a median of 6 years showed no Barrett's metaplasia in the residual esophagus. Seven patients had a reoperation for colon redundancy.

Long-term alimentary satisfaction and quality of life were excellent after colon interposition. Most patients were free of dysphagia and few needed revision for redundancy. These results should encourage the use of a colon interposition in patients expected to survive long-term after esophagectomy.