“Higher rates of morbidity and mortality following colonic conduits are reported to be due to be associated with longer operating times and the additional colo-gastric and colo-colic anastomoses. Yet, colonic conduits have the advantages of being longer, acid resistant, and possess an excellent blood supply. No consensus regarding the optimum site of colonic conduit (right vs. left) or placement route (posterior mediastinal, retrosternal or subcutaneous) exists. The operation is usually carried out based on individual surgeons’ preferences and experience, and in the absence of randomised controlled trials, this situation is likely to continue. The aim of this systematic review and meta-analysis was
to determine the optimal site of colonic conduit and route of placement after adult oesophagectomy.”

“Colonic interposition after oesophagectomy is a challenging and complex procedure and the two most important factors that influence outcomes are the choice of colonic conduit and route of placement. If direct assessment of conduit blood supply at operation reveals that both the left colon and right colon are viable, any reasonable observer would agree that the available published evidence regarding the ideal choice of conduit is thin. In the absence of a randomised control trial, the practicalities of which would be formidable, the results of this comprehensive meta-analysis provides the best available evidence that has shown that the
optimum and safest colonic conduit with the lowest associated operative morbidity and mortality represents the left colon placed via the retrosternal route.”

Brown, Jade et al. “Colonic Interposition After Adult Oesophagectomy: Systematic Review and Meta-analysis of Conduit Choice and Outcome.” Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract vol. 22,6 (2018): Emory Users Request through ILLiad