Key Points

• Colon interposition is an alternative to gastric conduit that offers long length, acid resistance, consistent and robust blood supply, and potential for wide gastric margins for cancers of the esophagogastric junction.
• Reconstruction with a colon interposition is technically demanding and often used only in specialized centers.
• Technical details such as intraoperative arterial and venous assessment to determine colon viability, and straightening and anchoring the colon interposition to the diaphragm to prevent graft redundancy are crucial for successful outcome.
• Long-term function is excellent particularly after vagal-sparing esophagectomy with colon interposition.

A variety of methods have been used to re-establish gastrointestinal continuity after esophageal resection. Currently, the most common esophageal substitutes are stomach, colon, and small intestine. Although the most common replacement organ is the stomach, the colon is an excellent option for reconstruction because of its consistent blood supply, long length, and acid resistance. However, esophageal reconstruction with a colon interposition is a technically demanding operation, and minute details can have a major impact on graft survival and long-term function. In this chapter we outline the principles of colon interposition and focus on the technical details of the procedure. In addition, the postoperative management of these patients is discussed and the functional results of esophageal replacement with a colon graft are reviewed.