En Bloc Pancreaticoduodenectomy for Locally Advanced Right Colon Cancers

Locally advanced right colon cancer may invade adjacent tissue and organs. Direct invasion of the duodenum and pancreas necessitates an en bloc resection. Previously, this challenging procedure was associated with high morbidity and mortality; however, today, this procedure can be done more safely in experienced centers. The aim of this study is to report our experience on en bloc right colectomy with pancreaticoduodenectomy for locally advanced right colon cancers. Between 2000 and 2012, 5 patients underwent en bloc multivisceral resection. No major morbidities or perioperative mortalities were observed. Median disease-free survival time was 24.5 months and median overall survival time was 42.1 (range: 4.5–70.4) months in our series. One patient lived 70 months after multivisceral resection and underwent cytoreductive surgery and total pelvic exenteration during the follow-up period. In locally advanced right colon tumors, all adhesions should be considered as malign invasion and separation should not be done. The reasonable option for this patient is to perform en bloc pancreaticoduodenectomy and right colectomy. This procedure may result in long-term survival with acceptable morbidity and mortality rates. Multidisciplinary teamwork and multimodality treatment alternatives may improve the results.

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

Einstein (São Paulo) ◽

10.1590/s1679-45082010rc786 ◽

2010 ◽

Vol 8 (1) ◽

pp. 97-101 ◽

Cited By ~ 2

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).

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

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032009000200014 ◽

2009 ◽

Vol 46 (2) ◽

pp. 151-153 ◽

Cited By ~ 9

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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En Bloc Resection of the Duodenum for Locally Advanced Right Colon Adenocarcinoma

The American Surgeon ◽

10.1177/000313480707301031 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1063-1066 ◽

Cited By ~ 3

Author(s):

Ahmad N. Hakimi ◽

David K. Rosing ◽

Bruce E. Stabile ◽

Beverley A. Petrie

Keyword(s):

Colon Cancer ◽

Locally Advanced ◽

En Bloc Resection ◽

Bloc Resection ◽

Morbidity And Mortality ◽

Right Colon ◽

En Bloc ◽

Adjacent Structures ◽

Duodenal Invasion

Direct invasion of colorectal adenocarcinoma into adjacent structures occurs frequently, but only rarely is the duodenum involved. This study was undertaken to assess the safety and efficacy of en bloc resection of locally advanced right colon carcinoma invading the duodenum. A retrospective review of 49 patients with locally advanced colon cancer, surgically managed between 2000 and 2005, was performed. Forty-six patients underwent en bloc resection of colon and adjacent organs not involving the duodenum. Three patients with duodenal invasion underwent en bloc partial duodenectomy. The mean operative blood loss, length of stay, postoperative morbidity, and mortality compare favorably between these two groups of patients. Of the 46 patients with en bloc resection of other organs, 27 are alive at 12 to 60 months follow up. Two patients with duodenal invasion are alive without recurrence at 15 and 20 months follow up. En bloc resection of colon cancer invading the duodenum can be performed safely because morbidity and mortality rates are comparable to those attending extended resections of other locally advanced colon carcinomas. Overall survival in patients who underwent surgery with curative intent justifies en bloc duodenal resection in selected patients.

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OR25-07 A Multi-Center, Open-Label, Pivotal Phase 2 Study of Azedra® (HSA I-131-MIBG) in Patients with Unresectable, Locally Advanced or Metastatic Pheochromocytoma or Paraganglioma: Updated Long-Term Survival and Safety

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1241 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Camilo Jimenez ◽

Bennett B Chin ◽

Richard B Noto ◽

Joseph Stephen Dillon ◽

Lilja B Solnes ◽

...

Keyword(s):

Overall Survival ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Locally Advanced ◽

Phase 2 ◽

Pivotal Phase ◽

Term Survival ◽

Phase 2 Study ◽

Therapeutic Doses

Abstract Background: Pheochromocytoma/Paraganglioma (PPGL) are rare neuroendocrine tumors with a 5-yr survival rate as low as 12%. There is a high unmet medical need for effective treatment options for patients with advanced disease. AZEDRA®, a high-specific-activity iodine-131 meta-iodobenzylguanidine (HSA I-131-MIBG), is the first and only FDA-approved therapeutic radiopharmaceutical agent indicated for the treatment of adult and pediatric patients with iobenguane scan positive, unresectable, locally advanced or metastatic PPGL who require systemic anticancer therapy. Methods: Patients with advanced PPGL who were heavily pre-treated and were ineligible for curative surgery or chemotherapy received a dosimetric dose followed by up to two therapeutic doses (each at 296 MBq/kg to a max of 18.5 GBq). The primary endpoint, defined as the proportion of patients with at least 50% reduction of all antihypertensive medication(s) lasting ≥6 months, was met and previously reported. Updated secondary endpoints including overall survival (OS) and safety are reported. Results: A dosimetric dose of HSA I-131-MIBG was administered to 74 patients. Of those, 68 patients received one therapeutic dose and 50 received two doses of HSA I-131-MIBG. Clinical benefit rates (objective tumor responses defined by RECIST 1.0 and stable disease) were observed in 71.4% and 98.0% of patients receiving one and two therapeutic doses, respectively. As of October 10, 2019, median survival time for all patients was 43.2 months (95% CI 31.4, >60). Median survival time was 19.3 months (95% CI 4.5, 32.4) and 49.1 months (95% CI 36.9, >60) in patients receiving one and two doses, respectively. The overall survival was 73.8% at 2 yrs, 47.5% at 4 yrs and 41.5% at 5 yrs. The most common (≥50%) adverse events were nausea, fatigue, and myelosuppression. Myelosuppressive events resolved within 4-8 wks without requiring stem cell transplantation. Late radiation toxicity included 7 patients with secondary malignancies (myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), colon cancer, and lung carcinoma) of which MDS, ALL and AML were considered related to I-131 radiotherapy. Conclusions: Results from this pivotal phase 2 study suggest that HSA I-131-MIBG is an efficacious and safe treatment for advanced PPGL.

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Cardiovascular and Metabolic Consequences of Liver Transplantation: A Review

Medicina ◽

10.3390/medicina55080489 ◽

2019 ◽

Vol 55 (8) ◽

pp. 489

Author(s):

Plotogea ◽

Ilie ◽

Sandru ◽

Chiotoroiu ◽

Bratu ◽

...

Keyword(s):

Metabolic Syndrome ◽

Liver Transplantation ◽

De Novo ◽

Current Knowledge ◽

Morbidity And Mortality ◽

High Morbidity ◽

Term Survival ◽

The Metabolic Syndrome ◽

Acute Liver Disease

Liver transplantation (LT) is considered the curative treatment option for selected patients who suffer from end-stage or acute liver disease or hepatic malignancy (primary). After LT, patients should be carefully monitored for complications that may appear, partially due to immunosuppressive therapy, but not entirely. Cardiovascular diseases are frequently encountered in patients with LT, being responsible for high morbidity and mortality. Patients with underlying cardiovascular and metabolic pathologies are prone to complications after the transplant, but these complications can also appear de novo, mostly associated with immunosuppressants. Metabolic syndrome, defined by obesity, hypertension, dyslipidemia, and hyperglycemia, is diagnosed among LT recipients and is aggravated after LT, influencing the long-term survival. In this review, our purpose was to summarize the current knowledge regarding cardiovascular (CV) diseases and the metabolic syndrome associated with LT and to assess their impact on short and long-term morbidity and mortality.

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Pancreaticoduodenectomy outcomes for locally advanced right colon cancers: A systematic review

Surgery ◽

10.1016/j.surg.2019.04.020 ◽

2019 ◽

Vol 166 (2) ◽

pp. 223-229 ◽

Cited By ~ 2

Author(s):

Marian Khalili ◽

Lynsey Daniels ◽

Elizabeth M. Gleeson ◽

Nikhil Grandhi ◽

Aditya Thandoni ◽

...

Keyword(s):

Systematic Review ◽

Locally Advanced ◽

Right Colon ◽

Colon Cancers

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En Bloc Pancreaticoduodenectomy and Right Colectomy in the Treatment of Locally Advanced Colon Cancer

Diseases of the Colon & Rectum ◽

10.1097/dcr.0b013e3182941704 ◽

2013 ◽

Vol 56 (7) ◽

pp. 874-880 ◽

Cited By ~ 13

Author(s):

Ji Zhang ◽

Jia-hua Leng ◽

Hong-gang Qian ◽

Hui Qiu ◽

Jian-hui Wu ◽

...

Keyword(s):

Colon Cancer ◽

Locally Advanced ◽

Right Colectomy ◽

En Bloc ◽

Advanced Colon Cancer

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Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽

10.1227/neu.0b013e3182446742 ◽

2011 ◽

Vol 70 (5) ◽

pp. 1055-1059 ◽

Cited By ~ 12

Author(s):

Yi-Ren Chen ◽

Maxwell Boakye ◽

Robert T. Arrigo ◽

Paul S. A. Kalanithi ◽

Ivan Cheng ◽

...

Keyword(s):

Elderly Patients ◽

Hospital Stay ◽

Treatment Modality ◽

The Elderly ◽

Morbidity And Mortality ◽

High Morbidity ◽

Complication Rates ◽

Term Survival ◽

Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

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En bloc resection in giant bilobed splenic artery aneurysm

BMJ Case Reports ◽

10.1136/bcr-2021-244319 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244319

Author(s):

Venu Bhargava Mulpuri ◽

Jayanta Samanta ◽

Pankaj Gupta ◽

Vikas Gupta

Keyword(s):

Early Detection ◽

Splenic Artery ◽

Artery Aneurysm ◽

En Bloc Resection ◽

Bloc Resection ◽

Morbidity And Mortality ◽

Splenic Artery Aneurysm ◽

High Morbidity ◽

En Bloc ◽

Distal Pancreas

Giant splenic artery aneurysms are rare and associated with high morbidity and mortality. Early detection is the key to decreasing morbidity and mortality. We present a giant splenic artery aneurysm which was managed by en bloc resection of the spleen, distal pancreas.

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