A Case of Curative Resection after Neoadjuvant Chemotherapy in Locally Advanced, Unresectable Right Colon Cancer

2009 ◽  
Vol 5 (1) ◽  
pp. 27-30
Author(s):  
Soon Do Park ◽  
Kil Yeon Lee ◽  
Sun Jin Park ◽  
Sang Mok Lee ◽  
Sung Wha Hong
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

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).


2020 ◽  

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.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Shunsuke Tabe ◽  
Toru Tonooka ◽  
Isamu Hoshino ◽  
Nobuhiro Takiguchi ◽  
Hiroaki Soda ◽  
...  

Abstract Background The strategy for treating obstructive colon cancers with metastatic lesions remains unclear. Herein, we report a case of laparoscopic ileo-transverse colon bypass (LITB) before preoperative chemotherapy for an obstructive right colon cancer. Case presentation A 59-year-old woman was referred to our institution (Department of Gastroenterological Surgery, Chiba Cancer Center) for liver tumors detected on ultrasound. The clinical diagnosis was ascending colon cancer with multiple liver metastases. Based on the criteria of the International Union against Cancer Committee, 8th edition, the staging was confirmed as cT4aN1M1a(H), cStage IV. Although the primary tumor in the ascending colon extended beyond the colonic wall, curative resection was possible for both primary and metastatic tumors. We planned to administer chemotherapy before the radical surgery to obtain tumor-free resection margins; however, as the obstruction was fatal, LITB was prioritized and performed using five ports. An intracorporeal side-to-side anastomosis was performed between the ileum, 25 cm from the terminal ileum, and the transverse colon. The patient was discharged on postoperative day 18 without any complications. After LITB, for preoperative chemotherapy, five courses of capecitabine plus oxaliplatin (CapeOX) + bevacizumab were administered. Six weeks after the preoperative chemotherapy, right hemicolectomy with D3 lymph node dissection and right hepatectomy were performed. Pathological findings of the resected specimen confirmed curative resection of both lesions, and a favorable effect of chemotherapy was obtained. The patient has been alive for over 8 months after the surgery, with no evidence of cancer recurrence. Conclusions This case report demonstrates the effectiveness of LITB for obstructive right colon cancer in patients who need preoperative chemotherapy.


2014 ◽  
Vol 23 (2) ◽  
pp. 92-98 ◽  
Author(s):  
Roberto Cirocchi ◽  
Stefano Partelli ◽  
Elisa Castellani ◽  
Claudio Renzi ◽  
Amilcare Parisi ◽  
...  

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Toshio Shiraishi ◽  
Tetsuro Tominaga ◽  
Takashi Nonaka ◽  
Kiyoaki Hamada ◽  
Masato Araki ◽  
...  

AbstractSingle-incision laparoscopic surgery (SILS) has the potential to improve perioperative outcomes, including less postoperative pain, shorter operation time, less blood loss, and shorter hospital stay. However, SILS is technically difficult and needs a longer learning curve. Between April 2016 and September 2019, a total of 198 patients with clinical stage I/II right colon cancer underwent curative resection. In the case of the SILS approach, an organ retractor was usually used to overcome SILS-specific restrictions. The patients were divided into two groups by surgical approach: the SILS with organ retractor group (SILS-O, n = 33) and the conventional laparoscopic surgery group (LAC, n = 165). Clinical T status was significantly higher in the LAC group (p = 0.016). Operation time was shorter and blood loss was lower in the SILS-O group compared to the LAC group (117 vs. 197 min, p = 0.027; 10 vs. 25 mL, p = 0.024, respectively). In the SILS-O group, surgical outcomes including operation time, blood loss, number of retrieved lymph nodes, and postoperative complications were not significantly different between those performed by experts and by non-experts. Longer operation time (p = 0.041) was significantly associated with complications on univariate and multivariate analyses (odds ratio 2.514, 95%CI 1.047–6.035, p = 0.039). SILS-O was safe and feasible for right colon cancer. There is a potential to shorten the learning curve of SILS using an organ retractor.


Author(s):  
Rathin Gosavi ◽  
Clemente Chia ◽  
Michael Michael ◽  
Alexander G. Heriot ◽  
Satish K. Warrier ◽  
...  

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