Colonic interposition in esophagectomy: an ACS-NSQIP study

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Databases

Background:

• Esophagectomy with gastric pull-up (GPU) or colonic interposition (CI) reconstructs the esophagus after cancer or injury.
• Both procedures aim to restore function but are linked to significant patient morbidity.

Purpose of the Study:

• To compare outcomes between gastric pull-up (GPU) and colonic interposition (CI) for esophageal reconstruction.
• To identify factors influencing reoperation, readmission, and mortality in these procedures.

Main Methods:

• Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
• Inclusion of patients undergoing GPU or CI between 2006 and 2020.
• Statistical analysis including univariate and multivariate logistic regression to assess outcomes.

Main Results:

• 12,545 GPU and 502 CI patients were analyzed.
• Colonic interposition (CI) was associated with longer hospital stays and higher reoperation rates (23.9% vs. 14.5%).
• Multivariate analysis indicated CI increased reoperation risk, but not readmission or mortality, suggesting patient frailty as a key factor.

Conclusions:

• Colonic interposition (CI) is a viable option when gastric reconstruction is not feasible.
• Observed outcome disparities are likely attributable to patient comorbidities and frailty rather than the inherent risks of CI.
• Further research into patient selection and risk stratification for esophageal reconstruction is warranted.