Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2017; 9(9): 372-378
Published online Sep 15, 2017. doi: 10.4251/wjgo.v9.i9.372
En bloc pancreaticoduodenectomy and right hemicolectomy for locally advanced right-sided colon cancer
Yuji Kaneda, Hiroshi Noda, Yuhei Endo, Nao Kakizawa, Kosuke Ichida, Fumiaki Watanabe, Takaharu Kato, Yasuyuki Miyakura, Koichi Suzuki, Toshiki Rikiyama
Yuji Kaneda, Hiroshi Noda, Yuhei Endo, Nao Kakizawa, Kosuke Ichida, Fumiaki Watanabe, Takaharu Kato, Yasuyuki Miyakura, Koichi Suzuki, Toshiki Rikiyama, Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
Author contributions: Kaneda Y collected the data and drafted the manuscript; Noda H and Rikiyama T designed the research and supervised the report; Endo Y, Kakizawa N, Ichida K, Watanabe F, Kato T, Miyakura Y and Suzuki K were involved in editing the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Saitama Medical Center, Jichi Medical University.
Informed consent statement: Patients were not required to give their informed consent for inclusion in this retrospective study, because we used anonymous clinical data and individual cannot be identified according to the data present. We announced this study on our institution’s website and explained about patients’ right to refuse inclusion in this study and about the study’s publication.
Conflict-of-interest statement: The authors declare no conflicts of interest in relation to this article.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroshi Noda, MD, PhD, Associate Professor of Medicine, Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan. noda164@omiya.jichi.ac.jp
Telephone: +81-486-472111 Fax: +81-486-485188
Received: January 28, 2017
Peer-review started: February 8, 2017
First decision: May 3, 2017
Revised: May 20, 2017
Accepted: July 14, 2017
Article in press: July 17, 2017
Published online: September 15, 2017
Abstract
AIM

To assess the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy (RHCPD) for locally advanced right-sided colon cancer (LARCC).

METHODS

We retrospectively reviewed the database of Saitama Medical Center, Jichi Medical University, between January 2009 and December 2016. During this time, 299 patients underwent radical right hemicolectomy for right-sided colon cancer. Among them, 5 underwent RHCPD for LARCC with tumor infiltration to adjacent organs. Preoperative computed tomography (CT) was routinely performed to evaluate local tumor infiltration into adjacent organs. During the operation, we evaluated the resectability and the amount of infiltration into the adjacent organs without dissecting the adherent organs from the cancer. When we confirmed that radical resection was feasible and could lead to R0 resection, we performed RHCPD. The clinical data were carefully reviewed, and the demographic variables, intraoperative data, and postoperative parameters were recorded.

RESULTS

The median age of the 5 patients who underwent RHCPD for LARCC was 70 years. The tumors were located in the ascending colon (three patients) and transverse colon (two patients). Preoperative CT revealed infiltration of the tumor into the duodenum in all patients, the pancreas in four patients, the superior mesenteric vein (SMV) in two patients, and tumor thrombosis in the SMV in one patient. We performed RHCPD plus SMV resection in three patients. Major postoperative complications occurred in 3 patients (60%) as pancreatic fistula (grade B and grade C, according to International Study Group on Pancreatic Fistula Definition) and delayed gastric empty. None of the patients died during their hospital stay. A histological examination confirmed malignant infiltration into the duodenum and/or pancreas in 4 patients (80%), and no patients showed any malignant infiltration into the SMV. Two patients were histologically confirmed to have tumor thrombosis in the SMV. All of the tumors had clear resection margins (R0). The median follow-up time was 77 mo. During this period, two patients with tumor thrombosis died from liver metastasis. The overall survival rates were 80% at 1 year and 60% at 5 years. All patients with node-negative status (n = 2) survived for more than seven years.

CONCLUSION

This study showed that the long-term survival is possible for patients with LARCC if RHCPD is performed successfully, particularly in those with node-negative status.

Keywords: Locally advanced right-sided colon cancer, Right hemicolectomy, Malignant infiltration, Inflammatory adhesion, Pancreaticoduodenectomy

Core tip: In this study, we retrospectively assessed the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy (RHCPD) in five patients with locally advanced right-sided colon cancer (LARCC) with malignant infiltration into adjacent organs. A histological examination confirmed malignant infiltration into the duodenum and/or pancreas in four patients, with no malignant infiltration into the superior mesenteric vein. The OS rates were 80% at 1 year and 60% at 5 years. All patients with node-negative status survived more than seven years without recurrence. The long-term survival is possible for patients, particularly node-negative ones, with LARCC if the RHCPD is performed successfully.