Kaneda Yuji, Noda Hiroshi, Endo Yuhei, Kakizawa Nao, Ichida Kosuke, Watanabe Fumiaki, Kato Takaharu, Miyakura Yasuyuki, Suzuki Koichi, Rikiyama Toshiki
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan.
World J Gastrointest Oncol. 2017 Sep 15;9(9):372-378. doi: 10.4251/wjgo.v9.i9.372.
To assess the usefulness of right hemicolectomy with pancreaticoduodenectomy (RHCPD) for locally advanced right-sided colon cancer (LARCC).
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.
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 ( = 2) survived for more than seven years.
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.
评估右半结肠切除术联合胰十二指肠切除术（RHCPD）治疗局部进展期右侧结肠癌（LARCC）的有效性。
我们回顾性分析了2009年1月至2016年12月期间秩父会医科大学埼玉医疗中心的数据库。在此期间，299例患者接受了右侧结肠癌根治性右半结肠切除术。其中，5例因肿瘤浸润至邻近器官的LARCC患者接受了RHCPD。常规进行术前计算机断层扫描（CT）以评估局部肿瘤向邻近器官的浸润情况。手术过程中，我们在不将粘连器官从癌组织上分离的情况下评估了切除的可行性以及向邻近器官的浸润程度。当我们确认根治性切除可行且能实现R0切除时，我们进行了RHCPD。仔细回顾临床资料，并记录人口统计学变量、术中数据和术后参数。
5例接受RHCPD治疗LARCC的患者中位年龄为70岁。肿瘤位于升结肠（3例）和横结肠（2例）。术前CT显示所有患者肿瘤均浸润至十二指肠，4例浸润至胰腺，2例浸润至肠系膜上静脉（SMV），1例SMV内有肿瘤血栓形成。3例患者进行了RHCPD加SMV切除。主要术后并发症发生在3例患者（60%），表现为胰瘘（根据国际胰腺瘘定义研究组为B级和C级）和胃排空延迟。住院期间无患者死亡。组织学检查证实4例患者（80%）有恶性肿瘤浸润至十二指肠和/或胰腺，无患者显示有恶性肿瘤浸润至SMV。2例患者经组织学证实SMV内有肿瘤血栓形成。所有肿瘤切缘均清晰（R0）。中位随访时间为77个月。在此期间，2例有肿瘤血栓形成的患者死于肝转移。1年总生存率为80%，5年总生存率为6%。所有淋巴结阴性状态的患者（n = 2）存活超过7年。
本研究表明，如果成功进行RHCPD，LARCC患者可能获得长期生存，尤其是那些淋巴结阴性状态的患者。
