Pancreatoduodenectomy for locally advanced or recurrent colon cancer: Report of two cases

Abstract

A 66-year-old man, who had ascending colon cancer which invaded the duodenum, pancreas, and superior mesenteric vein, underwent a curative resection including an extended right hemicolectomy, pylorus-preserving pancreatoduodenectomy, and a partial resection of the superior mesenteric vein. The pathological examination revealed adenocarcinoma of the colon, which directly invaded the duodenum and pancreas, thus causing duodenocolic fistula. Tumor infiltration to the superior mesenteric vein was not histologically proven. Two out of 40 lymph nodes were also involved. The patient is still alive and disease-free 37 months after the operation. A 72-year-old man, with a history of surgery two previous times for ascending colon cancer and its recurrence, underwent a third operation including a resection of the former ileocolic anastomosis en bloc by means of a pylorus-preserving pancreatoduodenectomy with a curative intent. The pathological examination revealed adenocarcinoma of the colon, which directly invaded the duodenum and pancreas. Seven out of 31 lymph nodes were also involved. The patient died of recurrence 24 months after the third operation. These two cases demonstrated the usefulness of a resection of the colon en bloc by means of a pancreatoduodenectomy in patients with either locally advanced colon cancer or locally advanced recurrent colon cancer.

En bloc pancreaticoduodenectomy and right hemicolectomy to treat locally advanced right colon cancer: report of three cases

“…Clinical examination may demonstrate a right upper quadrant mass, as observed in case 2 (12) . Computed tomography may sometimes show a hypodense mass in which the adjacent organs are involved, as in the third case of this study (8,(12)(13) . More rarely, preoperative radiological examination may show no locoregional invasion, but invasion of neighboring organs is diagnosed upon intraoperative evaluation, as we observed in case 2.…”

“…Even en bloc pancreaticoduodenectomy should sometimes be performed aiming at achieve free margins (6)(7)(8)(9)(10)(11)(12)(13)(14) . Adjuvant chemotherapy for locally invasive tumors is of uncertain merit.…”

“…Locally advanced cancer of the right colon that adheres to the proximal duodenum or head of the pancreas presents a challenge, even for skilled surgeons. This situation may require complex and difficult surgical resolution that involves en bloc pancreaticoduodenectomy plus right hemicolectomy (8)(9)(10)(11)(12)(13)(14) . Since few reports have been published regarding this uncommon clinical situation, the present study reports on three cases of en bloc pancreaticoduodenectomy plus right hemicolectomy for locally advanced right colon cancer.…”

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

“…Even en-bloc pancreatoduodenectomy should sometimes be performed with the aim of achieving free margins (1,2,3,4,5) .…”

“…Locally advanced cancer of the right colon that adheres to the proximal duodenum or head of the pancreas presents a challenging problem, even for skilled surgeons. This situation may require complex and difficult surgical resolution (1,2,3,4,5) .…”