To evaluate the safety of colonic interposition after esophagectomy.One hundred and thirty six patients with esophageal cancer underwent colonic interposition after esophagectomy in the Sichuan Tumor Hospital from October 1992 to October 2010. Clinical data of these patients were retrospectively reviewed.Out of the 136 patients, 118 grafts were transverse colon in clockwise peristalsis supplied by ascending branches of the left colonic artery. Twelve grafts were right part of transverse colon and ascending colon in clockwise peristalsis. Six grafts were left part of transverse colon and descending colon in counterclockwise peristalsis. All the 18 grafts were supplied by the middle colonic artery. The total perioperative complication rate was 26.4% (36/136), including anastomotic leakage in 15 cases, colon necrosis in 5 cases. The mortality was 12.5%(17/136), in which 5 patients died of colonic perforation, 4 died of colon necrosis, 4 died of severe lung infection after operation, 3 died of ARDS and 1 died of systemic infection of unknown origin. Anastomotic stenosis occurred in 2 patients, reflux in 2 cases, and 3 patients suffered from bowel dysmotility.Colon interposition is a complex procedure with significant trauma, high morbidity, and mortality. However, it is a valid alternative to reconstruct the gastrointestinal tract when the stomach is not feasible.