Management of patients with carcinoma of the right colon invading the duodenum or pancreatic head

Abstract

Morbidity and mortality after colectomy and en bloc partial duodenectomy or pancreaticoduodenectomy are high but in selected cases could offer prolonged survival. Aggressive surgery including major resection should be performed to obtain clear resection margins even in case of complicated forms.

Thirty-Day Outcomes in Patients Treated with En Bloc Colectomy and Pancreatectomy for Locally Advanced Carcinoma of the Colon

“…10,[17][18][19] Kapoor et al 9 described two patients out of six who returned to the OR. Fuks et al 6 described two patients that required return to the OR. Their study reported 3 pancreaticoduodenectomy patients and 12 lateral duodenectomy patients.…”

“…In up to 60-100% of the cases, adhesions between the tumor and adjacent structures are found to represent direct invasion upon histologic review. [6][7][8][9][10] If these principles are not followed, the consequences are notable. Early local recurrence rates of 70-100% are seen in patients who undergo separation of adjacent organs rather than en bloc resection.…”

“…Approximately 2.4% of colon cancers have been reported to invade the duodenum or head of the pancreas. 6 Correct oncologic principles in surgery for locally advanced colon cancer include en bloc resection of the tumor and involved adjacent organs. Importantly, it is impossible to reliably differentiate inflammatory adhesions of a tumor from direct invasion of other structures.…”

“…14 Since that time, there have been scattered reports in the literature from heterogeneous series of multivisceral resections. [4][5][6][9][10][11][15][16][17][18][19][20] Overall, there have been approximately 30 cases of colectomy with en bloc pancreaticoduodenectomy reported in the literature. The largest of these included seven patients.…”

Duodenocolic Fistula Caused by a Peptic Stomal Ulcer Following Distal Gastrectomy

“…We searched the medical literature using PubMed with the key words "duodenocolic fistula" from 1997 through 2012 and identified a total of 20 cases (2, 6-24). The etiology was benign in 10 cases (Crohn's disease (CD), 4 (6-9); foreign body ingestion, 1 (10); ulcerative colitis, 1 (11); duodenal ulcer, 1 (12); tuberculosis, 1 (13); abscess cavity, 1 (14); stent migration, 1 (15)) and malignant in 10 cases (colon cancer, 8 (2,(16)(17)(18)(19)(20)(21)(22); lymph node metastasis from colon cancer, 2 (23,24)). The frequencies of the causal factors in the 136 cases of benign DCF, including our case, are listed in Table 2.…”