Background <p>Colonic interposition is the preferred option for alimentary tract reconstruction when a gastric conduit pull-up is not feasible. Aim of this study was to evaluate perioperative outcomes of patients undergoing colonic interposition for various indications in our tertiary-care center over a 15-year period.</p> Methods <p>Following institutional board approval, all consecutive patients who underwent colonic interposition for esophageal replacement were identified from a prospectively maintained database. Comprehensive chart review and descriptive statistical analyses were performed.</p> Results <p>Ninety-three patients (62 men, 31 women, median age 65 years, IQR 55.5–72) underwent colonic interposition between January 2009 and December 2023. Benign disease was present in 17.2%, whereas malignancy accounted for 82.8%. A hand-sewn cervical anastomosis was performed in 96.8% of patients. The colonic graft, predominantly based on the left colic artery (89.2%) was routed through the posterior mediastinum in 51.6% and via the retrosternal route in 47.3%. Median operative time was 303&#xa0;min (IQR 247.5–364). Major complications included anastomotic leakage (28%), anastomotic stenosis (30.1%), pleural empyema (11.8%), and postoperative bleeding (10.8%). The reoperation rate was 38.7%, with a median hospital stay of 29 days (IQR 20–63). In-hospital mortality was 18.3%.</p> Conclusion <p>Colonic interposition after esophagectomy is associated with substantial morbidity and mortality, particularly in the salvage and secondary reconstruction setting, and should be confined to experienced, high-volume centers.</p> Clinical registration number <p>FMS_D_007.23-I-1</p>