Abstract
BackgroundEn bloc right hemicolectomy with pancreatoduodenectomy (RHCPD) is the optimum treatment to achieve the adequate margin of resection (R0) for locally advanced right-sided colon cancer with duodenal invasion. Information regarding the indications and outcomes of this procedure is limited.MethodIn this retrospective study, 2269 patients with right colon cancer underwent radical right colectomy between October 2010 and May 2019, in which 19 patients underwent RHCPD for LARCC were identified. The overall survival (OS), disease-free survival (DFS), operative mortality, postsurgical complications, gene mutational analysis, and prognostic factors were evaluated. Survival was estimated using Kaplan–Meir method.ResultsOf these 19 patients who underwent LARCC, the OS was 88%, 66%, and 58% at 1, 3, and 5 years. The DFS was 72%, 56%, and 56% at 1, 3, and 5 years. The median operative time was 320 min (range: 222–410 min), and the median operative blood loss was 268 mL (range: 100–600 mL). The OS was significantly better among patients with well-differentiated tumor, N0 stage, and high microsatellite instability (MSI) and in patients who received adjuvant chemotherapy. The major postoperative complications occurred in 8 patients (42%), with pancreatic fistula (PF) being the most common. On the basis of the univariate analysis, poorly differentiated tumor, regional lymph node dissemination, MSI status, and no perioperative chemotherapy were the significant predictors of poor survival (P < 0.05).ConclusionsThis study suggests that RHCPD is feasible and can achieve complete tumor clearance with favorable outcome, particularly in patients with lymph node-negative status.
Highlights
En bloc right hemicolectomy with pancreatoduodenectomy (RHCPD) is the optimum treatment to achieve the adequate margin of resection (R0) for locally advanced right-sided colon cancer with duodenal invasion
The major postoperative complications occurred in 8 patients (42%), with pancreatic fistula (PF) being the most common
Major postoperative complications occurred in 8 patients (42%) with clinically significant PF being the Patients characteristics Between October 2010 and May 2019, 2269 patients with primary right-sided colon cancer underwent radical Right colectomy (RC) at the Beijing Cancer Hospital
Summary
En bloc right hemicolectomy with pancreatoduodenectomy (RHCPD) is the optimum treatment to achieve the adequate margin of resection (R0) for locally advanced right-sided colon cancer with duodenal invasion. Clinicopathological findings and long-term outcomes of LARCC patients treated by RHCPD are rarely reported [5, 12, 15,16,17,18]. In China, the histologic findings and long-term survival of LARCC treated by RHCPD are rarely reported [5, 12, 19]. The potential relationship between the clinicohistologic-genetic status and prognosis is unknown In this retrospective study, we aimed to evaluate RHCPD in achieving radical tumor removal of LARCC patients with favorable outcomes and to identify prognostic factors of such patients with malignant involvement of adjacent organs as well as their gene expression and pathologic characteristics
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