Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Environmental Engineering, Dayeh University, Changhwa, Taiwan.
World J Emerg Surg. 2021 Feb 27;16(1):7. doi: 10.1186/s13017-021-00351-6.
En bloc right hemicolectomy plus pancreaticoduodenectomy (PD) is administered for locally advanced colon carcinoma that invades the duodenum and/or pancreatic head. This procedure may also be called colo-pancreaticoduodenectomy (cPD). Patients with such carcinomas may present with acute abdomen. Emergency PD often leads to high postoperative morbidity and mortality. Here, we aimed to evaluate the feasibility and outcomes of emergency cPD for patients with advanced colon carcinoma manifesting as acute abdomen.
We retrospectively reviewed 4898 patients with colorectal cancer who underwent curative colectomy during the period from 1994 to 2018. Among them, 30 had locally advanced right colon cancer and had received cPD. Among them, surgery was performed in 11 patients in emergency conditions (bowel obstruction: 6, perforation: 3, tumor bleeding: 2). Selection criteria for emergency cPD were the following: (1) age ≤ 60 years, (2) body mass index < 35 kg/m, (3) no poorly controlled comorbidities, and (4) perforation time ≤ 6 h. Three patients did not meet the above criteria and received non-emergency cPD after a life-saving diverting ileostomy, followed by cPD performed 3 months later. We analyzed these patients in terms of their clinicopathological characteristics, the early and long-term postoperative outcomes, and compared findings between emergency cPD group (e-group, n = 11) and non-emergency cPD group (non-e-group, n = 19). After cPD, staged pancreaticojejunostomy was performed in all e-group patients, and on 15 of 19 patients in the non-e-group.
The non-e-group was older and had a higher incidence of associated comorbidities, while other clinicopathological characteristics were similar between the two groups. None of the patients in the two groups succumbed from cPD. The postoperative complication rate was 63.6% in the e-group and 42.1% in the non-e-group (p = 0.449). The 5-year overall survival rate were 15.9% in the e-group and 52.6% in the non-e-group (p = 0.192).
Emergency cPD is feasible in highly selected patients if performed by experienced surgeons. The early and long-term positive outcomes of emergency cPD are similar to those after non-emergency cPD in patients with acute abdominal conditions.
整块右半结肠切除术加胰十二指肠切除术（PD）用于局部晚期侵犯十二指肠和/或胰头的结肠癌。这种手术也可以称为结肠-胰十二指肠切除术（cPD）。患有此类癌的患者可能会出现急性腹痛。紧急 PD 通常会导致术后高发病率和高死亡率。在这里，我们旨在评估对于表现为急性腹痛的晚期结肠癌患者行紧急 cPD 的可行性和结果。
我们回顾性分析了 1994 年至 2018 年期间接受根治性结肠切除术的 4898 例结直肠癌患者。其中 30 例为局部晚期右半结肠癌，接受了 cPD。其中，11 例在紧急情况下进行了手术（肠梗阻：6 例，穿孔：3 例，肿瘤出血：2 例）。紧急 cPD 的选择标准如下：（1）年龄≤60 岁，（2）体重指数<35kg/m，（3）无未控制的合并症，以及（4）穿孔时间≤6 小时。有 3 例患者不符合上述标准，在进行挽救生命的结肠造口术分流后接受非紧急 cPD，然后在 3 个月后进行 cPD。我们分析了这些患者的临床病理特征、早期和长期术后结果，并比较了紧急 cPD 组（e 组，n=11）和非紧急 cPD 组（非-e 组，n=19）的结果。在 cPD 后，所有 e 组患者均进行分期胰肠吻合术，19 例非-e 组患者中有 15 例进行了分期胰肠吻合术。
非-e 组年龄较大，合并症发生率较高，而两组其他临床病理特征相似。两组均无患者死于 cPD。e 组术后并发症发生率为 63.6%，非-e 组为 42.1%（p=0.449）。e 组 5 年总生存率为 15.9%，非-e 组为 52.6%（p=0.192）。
如果由经验丰富的外科医生进行，紧急 cPD 在高度选择的患者中是可行的。在出现急性腹痛的患者中，紧急 cPD 的早期和长期效果与非紧急 cPD 相似。
