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.

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.

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.

Intraoperative Radiochromoguided Mapping of Sentinel Lymph Node in Colon Cancer

2002 ◽  
Vol 88 (4) ◽  
pp. 352-353 ◽  
Author(s):  
P Nastro ◽  
M Sodo ◽  
CA Dodaro ◽  
S Gargiulo ◽  
W Acampa ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Regional Lymph Node ◽  
Gamma Probe ◽  
False Negative ◽  
Lymph Node Status ◽  
Blue Dye ◽  
Immunohistochemical Examination ◽  
Hematoxylin Eosin

Aims and Background The aim of our study was to assess the feasiblility of sentinel lymph node (SLN) detection in colon cancer using a radiochromoguided technique. The regional lymph node status is crucial for colorectal cancer staging and the stage of disease at the time of diagnosis is the main factor influencing therapeutic decision-making and patient survival. Methods and Study Design Between April and June 2001 eight patients with colon cancer were studied by radiochromoguided sentinel lymph node mapping. At the time of surgery 2 ml of patent blue dye was injected around the tumor, followed after 10 minutes by 2 ml of 99mTc-labeled albumin. After 30 minutes the SLN was identified by a gamma probe. Surgery was completed by standard resection. The SLN was processed for permanent hematoxylin and eosin staining and for immunohistochemical examination with anti-CEA and anti-cytokeratin antibodies. Results SLNs were identified in six patients; two were negative for metastasis by hematoxylin-eosin and immunohistochemical examination, two were positive for metastasis by both methods, and two were negative for metastasis by hematoxylin-eosin but positive by immunohistochemical examination. There were no false negative SLNs and no complications occurred. Conclusion The actual utility of SLN detection for prognostic purposes is still unknown, but intraoperative radiochromoguided SLN mapping is technically feasible in colon cancer, although it is associated with more technical difficulties than in breast cancer and malignant melanoma.

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 Lymph Node Status and Long-Term Oncologic Outcomes After Colon Resection in Locally Advanced Colon Cancer

2021 ◽  
Author(s):  
Artur M. Sahakyan ◽  
Andranik Aleksanyan ◽  
Hovhannes Batikyan ◽  
Hmayak Petrosyan ◽  
Mushegh А. Sahakyan
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Oncologic Outcomes ◽  
Lymph Node Status ◽  
Node Positive ◽  
Nodal Stage ◽  
Advanced Colon Cancer

AbstractLocally advanced colon cancer is associated with poor prognosis. The aim of this report was to examine the association between the lymph node status and prognosis of locally advanced colon cancer. Perioperative and oncologic outcomes were studied in patients who had undergone colectomy for colon cancer between June 2004 and December 2018. Locally advanced colon cancer was defined as stage T4a/T4b cancer. The long-term oncologic results were investigated in patients with non-metastatic locally advanced colon cancer. Of 195 patients operated for locally advanced colon cancer, 83 (42.6%), 43 (22.1%), and 69 (35.3%) had pN0, pN1, and pN2 disease, respectively. Preoperative serum levels of CEA and CA 19-9, as well as incidence of distant metastases were significantly higher in patients with pN2 compared to those with pN0 and pN1. In non-metastatic setting, a trend towards higher incidence of recurrence was observed in node-positive patients. Nodal stage was a significant predictor for survival in the univariable analysis but non-significant after adjusting for confounders. Subgroup analyses among the patients with T4a and T4b cancer did not demonstrate any association between the nodal stage and survival. Preoperative CA 19-9 > 37 U/ml and adjuvant chemotherapy were the only prognostic factors in T4a and T4b colon cancer, respectively. Although a trend towards higher incidence of recurrence was observed in node-positive locally advanced colon cancer, nodal stage was not associated with survival. Adjuvant chemotherapy should be strongly considered in T4b stage colon cancer.

scholarly journals 207 Laparoscopic versus Open Surgery for Locally Advanced Colon Cancer: A Retrospective Cohort Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P W L Tay ◽  
J L Xiao ◽  
W H Lim ◽  
N W Wong ◽  
C S Chong
Keyword(s):  
Colon Cancer ◽  
Retrospective Cohort ◽  
Open Surgery ◽  
Cohort Analysis ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Right Hemicolectomy ◽  
Surgical Methods ◽  
Significant Difference ◽  
T4 Colon Cancer

Abstract Introduction While an increasing number of studies substantiate the non-inferiority of laparoscopy to open surgery for pT4 colon cancer, studies investigating its value specific to the subgroup pT4a in right hemicolectomies remain scarce. Method We performed a retrospective cohort analysis in National University Hospital of Singapore of patients who underwent a right hemicolectomy for pT4 colon cancer. Statistical analysis was performed using Wilcoxon rank sum test and chi square/fisher exact. Results In total, 65 patients had T4 colon cancer. 55 underwent right hemicolectomy and 10 underwent extended right hemicolectomy. Baseline demographics were similar in laparoscopic (n = 27) and open (n = 38) groups, with no significant difference in proportion of pT4a patients (p = 0.724). For pT4, 30-day mortality (7%, 5% respectively, p = 0.723), overall survival (p = 0.1903) and disease-free survival (p = 0.3476) did not differ significantly between laparoscopic and open groups. R0 resection rates were significantly higher in laparoscopic group (p = 0.039). pT4a subgroup analysis found similar observations. Other complications including postoperative wound infection and anastomotic bleed were not significantly different for both T4 and T4a analysis. Conclusions This study presented comparable safety and oncological outcomes between the two surgical methods for right hemicolectomy, suggesting laparoscopy to be a viable alternative approach for locally advanced right colon cancer.

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