Kama N A, Reis E, Doganay M, Gozalan U, Yasti C
Fourth Department of Surgery, Ankara Numune Educational and Research Hospital, Ankara, Turkey.
Hepatogastroenterology. 2001 Jan-Feb;48(37):114-7.
BACKGROUND/AIMS: Adjacent organ invasion is observed in 5-12% of the colorectal cancers and is rarely faced with invasion of the duodenum, pancreas or liver.
We reviewed 4 patients with invasion of the duodenum, pancreas or liver or more than one at the same time, to emphasize the importance of aggressive radical procedures.
Three patients underwent en bloc pancreaticoduodenectomy with right hemicolectomy, and one patient underwent en bloc pancreaticoduodenectomy with right hemicolectomy and 5th and 6th hepatic segments resection. Perioperative need for blood transfusion was 3-5 units. There was no postoperative morbidity and mortality, except for the patient who had a bile leakage which got well with medical treatment. Although malignant invasion was proved by pathologic evaluation, only one patient had lymph node involvement. While one patient was lost at the 8th postoperative month, 3 patients are living disease free within a range of 14-41 months.
The chances of longer survival can be given to the patient by en bloc radical resections of locally advanced right colon tumors accompanied by invasion of duodenum, pancreas and liver, with low morbidity and mortality rates.
背景/目的：在5%-12%的结直肠癌中可观察到邻近器官侵犯，而侵犯十二指肠、胰腺或肝脏的情况较为罕见。
我们回顾了4例侵犯十二指肠、胰腺或肝脏或同时侵犯多个器官的患者，以强调积极根治性手术的重要性。
3例患者接受了胰十二指肠切除术联合右半结肠切除术，1例患者接受了胰十二指肠切除术联合右半结肠切除术及肝Ⅴ、Ⅵ段切除术。围手术期输血需求为3-5单位。除1例患者出现胆漏经药物治疗好转外，无术后并发症及死亡病例。虽然病理评估证实存在恶性侵犯，但仅1例患者有淋巴结受累。1例患者术后第8个月失访，3例患者在14-41个月内无病生存。
对于局部晚期右半结肠癌伴十二指肠、胰腺和肝脏侵犯的患者，行整块根治性切除术可提高患者长期生存几率，且发病率和死亡率较低。
