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

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 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 Pancreaticoduodenectomy for Locally Advanced Right Colon Cancers

International Journal of Surgical Oncology ◽

10.1155/2017/5179686 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Cihan Ağalar ◽

Aras Emre Canda ◽

Tarkan Unek ◽

Selman Sokmen

Keyword(s):

Survival Time ◽

Locally Advanced ◽

Multivisceral Resection ◽

Right Colectomy ◽

Morbidity And Mortality ◽

High Morbidity ◽

Right Colon ◽

En Bloc ◽

Term Survival ◽

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

10.22514/sv.2020.16.0095 ◽

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.

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

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00351-6 ◽

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.

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Total laparoscopic en bloc right hemicolectomy and pancreaticoduodenectomy with transvaginal specimen extraction for locally advanced right colon cancer: a case report

Gland Surgery ◽

10.21037/gs-20-800 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1780-1785

Author(s):

Haipeng Meng ◽

Hui Xu ◽

Xiaoming Wang ◽

Longyi Chen ◽

Fan Yang ◽

...

Keyword(s):

Colon Cancer ◽

Case Report ◽

Locally Advanced ◽

Right Hemicolectomy ◽

Right Colon ◽

Specimen Extraction ◽

En Bloc ◽

Right Colon Cancer ◽

Transvaginal Specimen Extraction

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Colo-pancreaticoduodenectomy for Locally Advanced Colon Carcinoma- Feasibility in Patients Manifesting as Acute Abdomen

10.21203/rs.3.rs-102628/v1 ◽

2020 ◽

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 BackgroundThe only curative option for locally advanced colon carcinoma invading duodenum and/or pancreatic head is the en-bloc right hemicolectomy plus pancreaticoduodenectomy (PD), so called colo-pancreaticoduodenectom (cPD). Patients with this disease may present as an acute abdomen. Emergent PD often has high postoperative morbidity and mortality. Here we aimed to evaluate the feasibility and outcomes of emergent cPD for such patients of advanced colon carcinoma, manifesting as life-threatening acute abdominal conditions.Patients and MethodsWe retrospectively review of 4,793 patients who underwent curative colectomy for the treatment of colorectal cancer in the period from 1993 and 2017. Among these patients, 30 had locally advanced right colon cancer and underwent a cPD. The cPD of 11 patients were performed in acute abdomen conditions (bowel obstruction 6, perforation 3, tumor bleeding 2). Selection criteria for emergent cPD were: (1) age ≦60 years, (2) body mass index <35 kg/m2, (3) no poorly-controlled comorbidities, and (4) perforation time ≤6 hours. Three patients who failed to meet these criteria received non-emergent cPD after a life-saving diverting ileostomy, and cPD was performed three months later. The patients clinicopathological characteristics, the early and long-term postoperative outcomes were compared between emergent cPD (e-group, n=11) and non-emergent cPD (non-e group, n=19). After cPD, staged pancreaticojejunostomy (PJ) was performed in all e-group, and on 15 of 19 non-e group patients.ResultsThe non-e group had significant higher patient age and higher incidence of associated comorbidities, while clinicopathological characteristics were otherwise similar. None of the patients in the two groups succumbed from cPD. 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 was 15.9% in the e-group, and 52.6% in the non-e-group (p=0.192).ConclusionsIn highly selected patients, emergent cPD is feasible by cooperation of experienced colorectal and pancreatic surgeons. The early and long-term outcomes of emergent and were similar to those after non-emergent cPD.

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Colo-pancreaticoduodenectomy for Locally Advanced Colon Carcinoma- feasibility in patients manifesting as Acute Abdomen

10.21203/rs.3.rs-102628/v2 ◽

2021 ◽

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 BackgroundFor locally advanced colon carcinoma that invades duodenum and/or pancreatic head is en-bloc right hemicolectomy plus pancreaticoduodenectomy (PD). This procedure may be also named as colo-pancreaticoduodenectomy (cPD). Patients with such carcinoma may abdomen. Emergent PD often leads to high postoperative morbidity and mortality. Here, we aimed to evaluate the feasibility and outcomes of emergent cPD, for patients with advanced colon carcinoma, manifest acute abdomen condition.Patients and MethodsWe retrospectively reviewed of 4,793 patients of colorectal cancer, receiving curative colectomy, during the period from 1993 and 2017. Among them, 30 had locally advanced right colon cancer and had received cPD. Among them, surgery of 11 patients was performed in emergent conditions (bowel obstruction 6, perforation 3, tumor bleeding 2). Selection criteria for emergent 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 hours. Three patients did not meet the above criteria received non-emergent cPD after a life-saving diverting ileostomy, followed by cPD, performed three months later. We analyzed these patients in terms of their clinicopathological characteristics, the early and long-term postoperative outcomes, and compared findings between emergent cPD group (e-group, n=11) and non-emergent cPD group (non-e group, n=19). After cPD, staged pancreaticojejunostomy was performed in all e-group, and on 15 of 19 patients in the non-e group. ResultsThe 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. 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 was 15.9% in the e-group, and 52.6% in the non-e-group (p=0.192).ConclusionsEmergent cPD is feasible in highly selected patients if performed by experienced surgeons. The early and long-term positive outcomes of emergent cPD are similar to those after non-emergent cPD in patients with acute abdominal conditions.

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Long term survival after right hemicolectomy and pancreatoduodenectomy for locally advanced colonic cancer: Case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2011.06.008 ◽

2011 ◽

Vol 2 (7) ◽

pp. 206-207 ◽

Cited By ~ 2

Author(s):

Iraklis Perysinakis ◽

Alexander Nixon ◽

Aggeliki Katopodi ◽

Emmanouil Tzirakis ◽

Despoina Georgiadou ◽

...

Keyword(s):

Case Report ◽

Colonic Cancer ◽

Locally Advanced ◽

Right Hemicolectomy ◽

Cancer Case ◽

Term Survival ◽

Long Term Survival ◽

Advanced Colonic Cancer

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

BMC Surgery ◽

10.1186/s12893-021-01286-0 ◽

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.

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