Long-Term Outcomes of Colon Conduits in Surgery for Primary Esophageal Cancer: A Propensity Score-Matched Comparison to Gastric Conduits

Background: In the treatment of esophageal cancer, a gastric conduit is typically the first choice. However, when the stomach is not a viable option, the usual alternative is a colon conduit. This study compared the long-term surgical outcomes of gastric and colon conduits over the same interval and aimed to identify factors influencing the prognosis. Methods: A retrospective review was conducted of patients who underwent esophagectomy followed by reconstruction for primary esophageal cancer between January 2006 and December 2020. Results: The study included 1,545 patients, with a gastric conduit used for 1,429 (92.5%) and a colon conduit for 116 (7.5%). Using propensity-matched analysis, 116 patients were selected from each group for comparison. No significant difference was observed in longterm survival between the gastric and colon conduit groups, irrespective of anastomosis level and pathological stage. A higher proportion of patients in the colon conduit group experienced postoperative complications compared to the gastric conduit group (57.8% vs. 25%, p<0.001). Multivariable analysis revealed that age over 65 years, body mass index below 22.0 kg/m(2), neoadjuvant therapy, postoperative anastomotic leakage, and renal failure were risk factors for overall survival in patients with a colon conduit. Regarding conduit-related complications, cervical anastomosis was the only significant risk factor among those with a colon conduit. Conclusion: Despite the association of colon conduits with high morbidity rates relative to gastric conduits, the long-term outcomes of colon conduits were acceptable. More consideration should be given perioperatively to the use of a colon conduit, particularly in cases involving cervical anastomosis.