Colon transposition in the management of upper gastrointestinal cancer

Restoration of swallowing after the resection of malignant disease in the upper gastrointestinal tract, including the pharynx, remains a surgical challenge. Recontructive techniques using a viscus are reviewed and 40 consecutive cases treated at the Royal Marsden Hospital (1965-1980) by colon transposition are reported. The major indication for this procedure was postradiation relapse of pharyngolaryngeal cancer requiring pharyngolaryngectomy. In 60% of the cases, a long-segment colon transposition was carried out through a retrosternal tunnel. The presternal subcutaneous route was used in one third of the cases and the posterior mediastinum in 7%. The 30-day operative mortality was 20% overall, but in recent years it was lowered to 7%. The major complications were cervical fistula (25%) and bronchopneumonia (20%), which frequently occurred together in patients who had undergone prior radiation therapy. Colon necrosis occurred in two cases. The functional outcome was satisfactory, with good results in 78%. Late structures due to marginal arteritis were observed if further radiation therapy was used in the cervical region. Where follow-up data was available, the mean survival was 36 months (range, 2-180; median 18 months) and the three-year survival rate was 32%. Colon transposition must remain an alternative to gastric transposition and is a durable esophageal substitute for long-term palliation.