Udo Ryutaro, Enomoto Masanobu, Tsurui Kazushige, Kuboyama Yuu, Kuwabara Hiroshi, Shigoka Masatoshi, Ishizaki Tetsuo, Katsumata Kenji, Obikane Hiyo, Tsuchida Akihiko
Dept. of Gastrointestinal Surgery and Pediatric Surgery, Tokyo Medical University.
Gan To Kagaku Ryoho. 2018 Apr;45(4):749-751.
There is a clear consensus regarding the combined resection of organs with cancer invasion, patients with colon cancer. However, there are very few reports to our knowledge regarding the use of pancreato-duodenectomy(PD)for colon cancer patients with cancer invasion in the duodenum. We here report a colon cancer patient in whom we performed PD and right hemicolectomy, who showed favorable results with no recurrence. The patient was a 69-year-old woman. Her chief complaint was hypogastric pain. Her previous doctor performed colonoscopy and a colonoscopic biopsy, and detected a type 2 lesion, throughout the entire circumference of the transverse colon near the liver, and she was diagnosed with adenocarcinoma. From further imaging analyses, she was diagnosed as having transverse colon cancer with invasion into the superior mesenteric vein(SMV), duodenum, and pancreatic head, and No. 223 lymph node metastasis. The patient's cancer was concluded to be unresectable, and she underwent chemotherapy, namely mFOLFOX6 with cetuxiumab(Cmab). One course of mFOLFOX with Cmab, the patient decided to consult our hospital for a second opinion. We concluded that her cancer was resectable, so we performed PD, right hemicolectomy, and resection and reconstruction of a part of the SMV. The operation time was 5 hours 17 minutes, and total blood loss was 190 mL. The histopathological diagnosis was tub2, T4b(duodenum and, tissue surrounding the SMV), int, INF b, ly1, v2, PN1b, EX(+)/ND(PN+, v+), PM0(25 cm), DM0(14.3 cm), N1(1/ 20), H0, P0, M0, pStage III a. She was discharged 15 days after surgery with no complications, and thereafter received ajduvant chemotherapy(capecitabine with oxaliplatin)as an outpatient. After 3 courses, capecitabine with oxaliplatin was changed to capecitabine because she developed a nervous system disorder, and she was further treated for approximately about 6 months. She is doing well at the time of writing, with no recurrences for 2 years. We suggest that PD should be performed on colon cancer patients in which the colon cancer has invaded other organs and has been evaluated as being unresectable.
对于合并有癌症侵犯的器官联合切除术，结肠癌患者存在明确的共识。然而，据我们所知，关于对十二指肠受癌症侵犯的结肠癌患者使用胰十二指肠切除术（PD）的报道非常少。我们在此报告一例接受了PD和右半结肠切除术的结肠癌患者，该患者术后效果良好，无复发。患者为一名69岁女性。她的主要诉求是下腹部疼痛。她之前的医生进行了结肠镜检查及结肠镜活检，在肝脏附近的横结肠全周发现了一个2型病变，她被诊断为腺癌。通过进一步的影像学分析，她被诊断为横结肠癌侵犯肠系膜上静脉（SMV）、十二指肠和胰头，并伴有第223组淋巴结转移。该患者的癌症被判定为不可切除，她接受了化疗，即mFOLFOX6联合西妥昔单抗（Cmab）。进行了一个疗程的mFOLFOX联合Cmab化疗后，患者决定到我院寻求第二种意见。我们判定她的癌症可切除，于是进行了PD、右半结肠切除术以及部分SMV的切除和重建。手术时间为5小时17分钟，总失血量为190毫升。组织病理学诊断为tub2，T4b（十二指肠及SMV周围组织），int，INF b，ly1，v2，PN1b，EX(+)/ND(PN+，v+)，PM0(25 cm)，DM0(14.3 cm)，N1(1/20)，H0，P0，M0，pStage III a。她术后15天出院，无并发症，此后作为门诊患者接受了辅助化疗（卡培他滨联合奥沙利铂）。3个疗程后，由于她出现了神经系统疾病，卡培他滨联合奥沙利铂改为卡培他滨，她又接受了大约6个月的进一步治疗。在撰写本文时，她情况良好，2年无复发。我们建议，对于结肠癌侵犯其他器官且被评估为不可切除的患者，应行PD手术。
