Efficacy of radical resection combined with pancreaticoduodenectomy for locally advanced right colon cancer: report of five cases
Objective:To assess the safety and effectiveness of radical resection combined with pancreaticoduodenectomy (PD) for the treatment of locally advanced right colon cancer.Methods:The clinical data of five patients with locally advanced colon cancer who underwent right hemicolectomy combined with PD at Peking University Shougang Hospital from April 2019 to December 2020 were analyzed retrospectively.Results:All the five patients were pathologically diagnosed as having colon adenocarcinoma. According to imaging evaluation, the tumor invaded the duodenum in three cases and invaded the duodenum and pancreas in two. Three cases received surgical treatment after preoperative systemic treatment, and two received surgical treatment directly. Radical resection of the right colon + PD was performed in two cases, radical resection of the right colon + PD + purse string gastrostomy in one, radical resection of the right colon + PD + resection and reconstruction of the superior mesenteric vein (SMV) plus tunnel small intestinal (jejunum) intubation in one, and radical resection of the right colon + PD + SMV reconstruction + external drainage of the pancreas + external drainage of the bile duct + external enterostomy of the small intestine (double lumen ileum) in one. Pancreatic fistula (biochemical leakage) occurred in all the five cases, delayed gastric emptying in one, chylous leakage in one, and incision infection in one. All postoperative complications were grade Ⅱ according to the Clavien-Dindo classification, and there were no complications of grade Ⅲ or above. There were two cases with liver metastasis after operation (both were treated with programmed death protein 1 (PD-1)), and their disease-free survival (DFS) was 17 and 21 months, respectively. Postoperative peritoneal metastasis occurred in two cases (one received postoperative chemotherapy and one did not receive chemotherapy), and their overall survival (OS) was 11 and 12 months, respectively. There was no metastasis or recurrence in one case, and the DFS was 33 months.Conclusion:Radical right colon resection combined with PD is safe and feasible for locally advanced right colon cancer. Postoperative adjuvant therapy can control tumor progression and prolong the survival of patients.
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