Right‑sided colon cancer with invasion of the duodenum or pancreas: A glimpse into our experience

Abstract

Duodenal or pancreatic invasion in locally advanced right colon cancer (LARCC) is a challenging situation that can pose difficulties in its management. When the duodenum alone is invaded, the surgeon may undertake right hemicolectomy (RH) en bloc with the affected patch of duodenum. The duodenal defect can be reconstructed using several techniques. When invasion of the pancreas is present, RH en bloc with duodenopancreatectomy (DP) is the treatment of choice. We present our experience regarding the treatment and prognostic results of this rare colon cancer form. We retrospectively reviewed the data of patients who underwent surgery for right-sided colon cancer with duodenal and/or pancreatic invasion between January 2004 and March 2020. Among the 110 patients with LARCC, pancreas and/or duodenum invasion was encountered in 22 patients, with a mean age of 49.5 years. From the 22 patients, 5 patients underwent palliative procedures, with a maximal survival of 15 months. Three patients underwent RH alone, with lethal outcome in the first year in 66% of the cases. RH en bloc with antrectomy was performed in 2 patients. Eight patients underwent RH with DP, with a 1-year survival of 75% (6/8) and a 5-year survival of 50% (3/6). Thirty-day mortality post-DP was noted in 25% (2/8) of the cases. Four patients underwent RH with limited duodenal resection, with no recurrence of disease at 11 to 39 months postoperatively. Among the duodenal defect restoration, simple duodenal suture was practiced in 2 patients, duodenojejunostomy in one patient and pedicled ileal flap in 1 case. In conclusion, although postoperative mortality can be significant, en bloc resection for LARCC invading the duodenum and/or pancreas offers prolonged survival in a considerable number of patients.