En Bloc Resection of Pancreaticoduodenectomy and Colectomy in Patients with Locally Advanced Right Coloncancer

Abstract

Locally advanced colorectal cancers, which are defined as tumors that remain localized and/or invade adjacent organs before distant metastasis occurs, constitute approximately 5-22% of all colorectal cancers at the time of presentation. Depending on the site, primary colorectal cancers may lead to perforation or invasion of adjacent organs such as the stomach, duodenum, upper jejunum, pancreas, abdominal wall, uterus, cervix, and urinary bladder. These advanced tumors are usually bulky but diagnosisis sometimes delayed because of the vagueness of their symptoms. Despite the development of advanced chemotherapy, radical surgical resection remains the only potentially curative treatment for these advanced colorectal cancers. Radiation and/or chemotherapy can rarely cure patients with unresected or incomplete resected colon cancer. However, surgeons sometimes need to weigh the potential benefit of extensive resections against the increased risk of morbidity and mortality with these operations. Lai et al. published their paper in this issue (page 135-140), entitled En bloc resection of pancreaticoduodenectomy and colectomy in patients with locally advanced right colon cancer. In this study, they retrospectively reviewed their experience with locally advanced primary hepatic flexure and transverse colon cancers in an attempt to justify extensive resectionon the basis of prognosis. They reported 11 patientsover a 20-year period who had undergone en bloc pancreaticoduodenectomy and colectomy for right colon cancer invading the duodenum or pancreas. The median disease-free survival was good (mean, 20.3 months) and 4 of 11 patients survived longer than 5 years. They thus concluded that pancreaticoduodenectomy should be justified for this disease. J Soc Colon Rectal Surgeon (Taiwan) December 2012