Abstract / Summary
Background/Objectives: Colon interposition, or esophagocoloplasty, remains an important reconstructive option when the native esophagus cannot be preserved or when the stomach is unsuitable for reconstruction. Malignant transformation within the interposed colon is rare but clinically relevant, because the transposed colonic mucosa retains the potential to develop adenomatous lesions and adenocarcinoma in the long term. Methods: We reviewed reported cases of malignancies arising in a colonic interposition after esophagocoloplasty. PubMed and Web of Science Core Collection were searched using the query “(Esophag*) AND ((Esophagectomy) OR (Esophagocoloplasty) OR (Interpos*) OR (Transpos*)) AND (Colon) AND (Cancer OR Adenocarcinoma) NOT (“Esophageal cancer” OR “Esophageal adenocarcinoma” OR “Gastric cancer” OR “Gastric Adenocarcinoma”)”. The search was limited to publications from 2005 to 2026. Results: After duplicate removal and eligibility screening, 20 case reports were included. We also present a 67-year-old man who underwent isoperistaltic coloesophagoplasty in 1979 after caustic ingestion during a suicide attempt and developed metastatic colon adenocarcinoma in the interposed graft approximately 44 years later. The disease was initially metastatic to the liver and subsequently progressed locoregionally in the cervical graft segment. Management included FOLFOX plus bevacizumab, de-escalation to FUFOL plus bevacizumab, FOLFIRI plus bevacizumab, cervical intensity-modulated radiotherapy with adaptive replanning, and later regorafenib. Conclusions: This case highlights the diagnostic and therapeutic complexity of adenocarcinoma arising in a cervical colonic graft and supports long-term vigilance, multidisciplinary evaluation, and individualized management in patients with prior esophagocoloplasty.