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 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 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.

Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum

2014 ◽  
Vol 23 (2) ◽  
pp. 92-98 ◽  
Author(s):  
Roberto Cirocchi ◽  
Stefano Partelli ◽  
Elisa Castellani ◽  
Claudio Renzi ◽  
Amilcare Parisi ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Locally Advanced ◽  
Right Hemicolectomy ◽  
Right Colon ◽  
Right Colon Cancer

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.

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

2007 ◽  
Vol 73 (10) ◽  
pp. 1063-1066 ◽  
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.

scholarly journals En bloc Resection for Right Colon Cancer Directly Invading Duodenum or Pancreatic Head

2009 ◽  
Vol 50 (6) ◽  
pp. 803 ◽  
Author(s):  
Won-Suk Lee ◽  
Woo Yong Lee ◽  
Ho-Kyung Chun ◽  
Seong-Ho Choi
Keyword(s):  
Colon Cancer ◽  
Pancreatic Head ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Right Colon ◽  
En Bloc ◽  
Right Colon Cancer

scholarly journals Neoadjuvant Chemoradiotherapy in Patients With Unresectable Locally Advanced Sigmoid Colon Cancer: Clinical Feasibility and Outcome

2021 ◽  
Author(s):  
Shao-Qing Niu ◽  
Rong-Zhen Li ◽  
Yan Yuan ◽  
Wei-Hao Xie ◽  
Qiao-Xuan Wang ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Sigmoid Colon ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Sigmoid Colon Cancer ◽  
Cumulative Probability ◽  
R0 Resection ◽  
Dismal Prognosis

Abstract Background: Patients with locally advanced sigmoid colon cancer (LASCC) have limited treatment options and a dismal prognosis with poor quality of life. This prospective study aimed to further evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by surgery as treatment for select patients with unresectable LASCC.Methods: We studied patients with unresectable LASCC who received NACRT between November 2010 and April 2019. The NACRT regimen consisted of intensity modulated radiotherapy (IMRT) of 50 Gy to the gross tumor and positive lymphoma nodes and 45 Gy to the clinical target volume. Capecitabine‑based chemotherapy was administered every 3 weeks. Surgery was scheduled 6–8 weeks after radiotherapy.Results: Seventy‑two patients were enrolled in this study. Patients had a regular follow-up (median, 41.1 months; range, 8.3–116.5 months). Seventy‑one patients completed NACRT, and sixty-five completed surgery. Resection with microscopically negative margins (R0 resection) was achieved in 64 patients (88.9%). Pathologic complete response was observed in 15 patients (23.1%), and multivisceral resection was necessary in 38 patients (58.3%). The cumulative probability of 3-year overall survival and disease‑free survival were 75.8% and 70.7%, respectively.Conclusion: For patients with unresectable LASCC, neoadjuvant chemoradiotherapy is feasible, surgery can be performed safely and may result in increased survival and organ preservation rates.

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