scholarly journals En bloc right hemicolectomy with pancreatoduodenectomy for right-sided colon cancer invading duodenum

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiao-Luan Yan ◽  
Kun Wang ◽  
Quan Bao ◽  
Hong-Wei Wang ◽  
Ke-min Jin ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Mutational Analysis ◽  
Regional Lymph Node ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Right Hemicolectomy ◽  
En Bloc ◽  
Right Colon Cancer

Abstract Background En bloc right hemicolectomy with pancreatoduodenectomy (RHCPD) is the optimum treatment to achieve the adequate margin of resection (R0) for locally advanced right-sided colon cancer with duodenal invasion. Information regarding the indications and outcomes of this procedure is limited. Method In this retrospective study, 2269 patients with right colon cancer underwent radical right colectomy between October 2010 and May 2019, in which 19 patients underwent RHCPD for LARCC were identified. The overall survival (OS), disease-free survival (DFS), operative mortality, postsurgical complications, gene mutational analysis, and prognostic factors were evaluated. Survival was estimated using Kaplan–Meir method. Results Of these 19 patients who underwent LARCC, the OS was 88%, 66%, and 58% at 1, 3, and 5 years. The DFS was 72%, 56%, and 56% at 1, 3, and 5 years. The median operative time was 320 min (range: 222–410 min), and the median operative blood loss was 268 mL (range: 100–600 mL). The OS was significantly better among patients with well-differentiated tumor, N0 stage, and high microsatellite instability (MSI) and in patients who received adjuvant chemotherapy. The major postoperative complications occurred in 8 patients (42%), with pancreatic fistula (PF) being the most common. On the basis of the univariate analysis, poorly differentiated tumor, regional lymph node dissemination, MSI status, and no perioperative chemotherapy were the significant predictors of poor survival (P < 0.05). Conclusions This study suggests that RHCPD is feasible and can achieve complete tumor clearance with favorable outcome, particularly in patients with lymph node-negative status.

scholarly journals En Bloc Right Hemicolectomy with Pancreaticoduodenectomy for Locally Advanced Right-Sided Colon Cancer

2020 ◽  
Author(s):  
Xiao-Luan Yan ◽  
Kun Wang ◽  
Quan Bao ◽  
Hong-Wei Wang ◽  
Ke-Min Jin ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Mutational Analysis ◽  
Regional Lymph Node ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Right Hemicolectomy ◽  
Lymph Node Status ◽  
En Bloc

Abstract Background: En bloc right hemicolectomy with pancreaticoduodenectomy (RHCPD) is the optimum treatment to achieve the adequate margin of resection (R0) for locally advanced right-sided colon cancer (LARCC). Information regarding the indications and outcomes of this procedure is limited.Method: In this retrospective study, patients who underwent RHCPD for LARCC during October 2010 to May 2019 were identified. The overall survival (OS), disease-free survival (DFS), mortality, postsurgical complications, gene mutational analysis, and prognostic factors were evaluated. Survival was estimated using Kaplan-Meir method.Results: Nineteen patients who underwent RHCPD were included in the study. The OS was 88.2%, 65.9%, and 57.6% at 1, 3, and 5 years. The DFS was 71.6%, 56.4%, and 56.4% at 1, 3, and 5 years. The median operative time was 320 minutes (range: 222-410 minutes), and the median operative blood loss was 268 mL (range: 100-600 mL). The OS was significantly better among patients with well-differentiated tumor (P=0.03), N0 stage (P=0.01), and high microsatellite instability (MSI) (P=0.047) and in patients who received chemotherapy (P=0.027). The major postoperative complications occurred in 8 patients (42%), with pancreatic fistula (PF) being the most common. On the basis of the univariate analysis, poorly differentiated tumor, regional lymph node dissemination, MSI status, and no perioperative chemotherapy were the significant predictors of poor survival (P<0.05). By multivariate analysis, only lymph node status was the significant factor (hazard ratio [HR]: 79.045; P=0.021).Conclusions: This study suggests that RHCPD is feasible and can achieve complete tumor clearance with favorable outcome, particularly in patients with lymph node-negative status.

Outcomes after combined right hemicolectomy and pancreaticoduodenectomy for locally advanced right-sided colon cancer: a case series

2020 ◽  
Keyword(s):  
Colon Cancer ◽  
Locally Advanced ◽  
Case Series ◽  
Disease Free Survival ◽  
Right Hemicolectomy ◽  
R0 Resection ◽  
Right Colon ◽  
En Bloc ◽  
Mortality And Morbidity ◽  
Right Colon Cancer

Background: Although right colon cancers mostly grow intraluminally, they may rarely invade neighboring organs without distant organ metastasis. En bloc resection is required for R0 resection in pancreas and duodenum-invasive right colon tumors. Despite the high mortality and morbidity rates, the en bloc right hemicolectomy and pancreaticoduodenectomy (RHPD) procedure can be safely performed in centers experienced in colorectal and hepatobiliary surgery. Objective: In this study, we aimed to share the results of our patients who underwent en bloc pancreaticoduodenectomy in addition to right hemicolectomy for cases with locally advanced right colon cancer. Materials and Methods: Patients who were operated on the right colon cancer between January 2010 and March 2018 were retrospectively screened. Patients who underwent RHPD due to locally advanced colon cancer invading the duodenum and pancreas were included in this study. RHPD was performed in cases where radical resection was deemed appropriate, and R0 resection could be performed. Demographic information, intraoperative and postoperative findings, and long-term follow-up data of the patients were recorded. Results: Six cases underwent RHPD. All of the cases were male, and the mean age was 67 ± 6. Proximal PD was performed in five cases, and total PD was performed in one case. SMV reconstruction was performed in one case with an SMV invasion. One case died due to pneumonia and anastomotic leak in the postoperative period. The other five patients had a mean disease-free survival of 29.2 ± 14.7 months. The 1 and 2-year survival rate was 66.6% and 66.6%, respectively. Conclusion: RHPD is a surgical operation that can be performed safely in experienced centers with acceptable mortality and morbidity rates in cases suitable for R0 resection.

scholarly journals En bloc pancreaticoduodenectomy and right hemicolectomy to treat locally advanced right colon cancer: report of three cases

2010 ◽  
Vol 8 (1) ◽  
pp. 97-101 ◽  
Author(s):  
Sergio Renato Pais Costa ◽  
Sergio Henrique Couto Horta ◽  
Alexandre Cruz Henriques ◽  
Jaques Waisberg ◽  
Manlio Basílio Speranzini
Keyword(s):  
Colon Cancer ◽  
Locally Advanced ◽  
Pancreatic Head ◽  
Multivisceral Resection ◽  
Right Hemicolectomy ◽  
Right Colon ◽  
En Bloc ◽  
Term Survival ◽  
Proximal Duodenum ◽  
Right Colon Cancer

ABSTRACT Although colorectal tumors are fairly common surgical conditions, 5 to 12% of these tumors are locally advanced (T4 tumors) upon diagnosis. In this particular situation, the efficacy of en bloc multivisceral resection has been proven. When right-colon cancer invades the proximal duodenum or even the pancreatic head, a challenging dilemma arises due to complexity of the curative surgical procedure. Therefore, en bloc pancreaticoduodenectomy with right hemicolectomy should be performed to obtain free margins. The present study reports three cases of locally advanced right-colon cancer invading the proximal duodenum. All of these cases underwent successful en bloc pancreaticoduodenectomy plus right hemicolectomy, with no death occurrence. Long-term survival was observed in two cases (30 and 50 months). In the third case, the patient did not present any recurrence twelve months after surgical treatment. Multivisceral resection with en bloc pancreaticoduodenectomy should be considered for patients who present acceptable risk for major surgery and no distant dissemination. This approach seems justified since the length of postoperative survival is longer in radically ressected groups (R0) than in palliativelly resected groups (R1-2).

scholarly journals Clinical analysis of metastatic characteristics of infrapyloric lymph nodes (No.206) and terminal ileum lymph nodes in patients with right colon cancer

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jiangrui Liu ◽  
Yibin Su ◽  
Xing Liu ◽  
Jinfu Zhuang ◽  
Yuanfeng Yang ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Terminal Ileum ◽  
Tumor Location ◽  
Right Hemicolectomy ◽  
Hepatic Flexure ◽  
Node Dissection ◽  
Right Colon Cancer

Abstract Background D3 or complete mesocolic excision (CME) surgery has become a common surgical procedure for the treatment of colon cancer metastasis. Clinical misuse and overuse of lymph node dissection bring unnecessary burdens to patients. A detailed guidance for lymph node dissection in patients with T3 and T4 stage right colon cancer at different locations is urgently needed. Methods A retrospective study was performed. Patients received D3 or CME surgery were divided into ileocecal group, ascending colon group, and hepatic flexure group according to the 9th edition of the Japanese Society for Cancer of the Colon and Rectum guidelines. The distributions of lymph node metastases were analyzed according to tumor infiltration depth (T stage) and tumor location. Results The incidence of metastases in the paracolic area (or station), intermediate area, and main (or central) area was 38.4% (139/362), 12.7% (46/362), and 9.7% (35/362), respectively. The proportion of patients having No.206 and terminal ileum lymph nodes metastases was 7.7% (14/181) and 3.7% (9/244), respectively. No.206 lymph node metastasis is related to tumor location (χ2 = 7.955, p = 0.019) and degree of differentiation (χ2 = 18.99, p = 0.000), and terminal ileum lymph node metastasis is related to tumor location (χ2 = 6.273, p = 0.043). Patients with T3/T4 hepatic flexure cancer received radical right hemicolectomy in addition to No.206 lymph node dissection. Conclusion Radical right hemicolectomy and No.206 group lymph node dissection are necessary for T3 and T4 stage colon cancer therapy.

scholarly journals Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Joe-Bin Chen ◽  
Shao-Ciao Luo ◽  
Chou-Chen Chen ◽  
Cheng-Chung Wu ◽  
Yun Yen ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Colon Carcinoma ◽  
Locally Advanced ◽  
Pancreatic Head ◽  
Right Hemicolectomy ◽  
Clinicopathological Characteristics ◽  
En Bloc ◽  
Right Colon Cancer ◽  
Tumor Bleeding

Abstract Background En bloc right hemicolectomy plus pancreaticoduodenectomy (PD) is administered for locally advanced colon carcinoma that invades the duodenum and/or pancreatic head. This procedure may also be called colo-pancreaticoduodenectomy (cPD). Patients with such carcinomas may present with acute abdomen. Emergency PD often leads to high postoperative morbidity and mortality. Here, we aimed to evaluate the feasibility and outcomes of emergency cPD for patients with advanced colon carcinoma manifesting as acute abdomen. Methods We retrospectively reviewed 4898 patients with colorectal cancer who underwent curative colectomy during the period from 1994 to 2018. Among them, 30 had locally advanced right colon cancer and had received cPD. Among them, surgery was performed in 11 patients in emergency conditions (bowel obstruction: 6, perforation: 3, tumor bleeding: 2). Selection criteria for emergency cPD were the following: (1) age ≤ 60 years, (2) body mass index < 35 kg/m2, (3) no poorly controlled comorbidities, and (4) perforation time ≤ 6 h. Three patients did not meet the above criteria and received non-emergency cPD after a life-saving diverting ileostomy, followed by cPD performed 3 months later. We analyzed these patients in terms of their clinicopathological characteristics, the early and long-term postoperative outcomes, and compared findings between emergency cPD group (e-group, n = 11) and non-emergency cPD group (non-e-group, n = 19). After cPD, staged pancreaticojejunostomy was performed in all e-group patients, and on 15 of 19 patients in the non-e-group. Results The non-e-group was older and had a higher incidence of associated comorbidities, while other clinicopathological characteristics were similar between the two groups. None of the patients in the two groups succumbed from cPD. The postoperative complication rate was 63.6% in the e-group and 42.1% in the non-e-group (p = 0.449). The 5-year overall survival rate were 15.9% in the e-group and 52.6% in the non-e-group (p = 0.192). Conclusions Emergency cPD is feasible in highly selected patients if performed by experienced surgeons. The early and long-term positive outcomes of emergency cPD are similar to those after non-emergency cPD in patients with acute abdominal conditions.

scholarly journals En-bloc pancreatoduodenectomy and right hemicolectomy for treating locally advanced right colon cancer (T4): a series of five patients

2009 ◽  
Vol 46 (2) ◽  
pp. 151-153 ◽  
Author(s):  
Sergio Renato Pais Costa ◽  
Alexandre Cruz Henriques ◽  
Sergio Henrique Couto Horta ◽  
Jaques Waisberg ◽  
Manlio Basílio Speranzini
Keyword(s):  
Locally Advanced ◽  
Colon Adenocarcinoma ◽  
Multivisceral Resection ◽  
Right Hemicolectomy ◽  
Major Surgery ◽  
Right Colon ◽  
En Bloc ◽  
Term Survival ◽  
Right Colon Cancer

A series of five cases of right-colon adenocarcinoma that invaded the proximal duodenum is presented. All patients underwent successful en-bloc pancreatoduodenectomy plus right hemicolectomy by General Surgery Service of the Teaching Hospital of the ABC Medical School, Santo André, SP, Brazil. The study was conducted between 2000 and 2007. There were two major complications but no mortality. Three patients did not present any recurrence over the course of 15 to 54 months of follow-up. Multivisceral resection with en-bloc pancreatoduodenectomy should be considered for patients who are fit for major surgery but do not present distant dissemination. Long-term survival may be attained.

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