Takeda Hiroyuki, Ishizaki Tetsuo, Udo Ryutaro, Tago Tomoya, Kasahara Kenta, Mazaki Junichi, Inoue Keiichiro, Nagakawa Yuichi
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Inoue Geka-Naika Clinic, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0146. Epub 2025 Apr 5.
While simultaneous complex surgical procedures such as right hemicolectomies with pancreaticoduodenectomies (RHPD) may increase overall surgical complexity, complications, and risk of death, it is the only cure for advanced ascending colon cancer (AACC) that has directly invaded the duodenum/pancreas. There are a few reports, especially from Japan. Here, we report an extremely rare case of a patient who underwent RHPD for AACC with direct invasion to the duodenum and liver and describe the patient's long-term survival after en bloc resection.
The patient was a 76-year-old man who presented with a chief complaint of right abdominal pain and weight loss of 12 kg over the past month. Colonoscopy revealed the entire circumference of a type 2 tumor in the ascending colon. Preoperative computed tomography showed a 12 cm mass lesion with wall thickening in the ascending colon which was also invading the second portion of the duodenum. MSI-H/dMMR was negative. RHPD and partial hepatectomy were performed with open surgery because of a preoperative diagnosis of clinical T4b (duodenum and liver) N1bM0 stage IIIc cancer. Although grade 2 adverse effects, which delayed gastric emptying was observed during the patient's postoperative course, the patient's condition resolved through conservative therapy. Oral intake started on postoperative day 17, and the patient was discharged on postoperative day 25. Capecitabine plus oxaliplatin was administered as adjuvant chemotherapy for 6 months. Hematoxylin and eosin staining revealed moderately differentiated adenocarcinoma invading the duodenum and liver. The patient was diagnosed as pathological T4b (duodenum and liver) N1bM0 stage IIIc cancer. No recurrence was noted up to 40 months after the surgery.
The only curative therapy for AACC with involvement of the duodenum is en bloc RHPD. Here, we described a case in which long-term survival was achieved by ensuring R0 with en bloc resection.
虽然同时进行的复杂外科手术，如右半结肠切除术联合胰十二指肠切除术（RHPD）可能会增加整体手术的复杂性、并发症和死亡风险，但对于直接侵犯十二指肠/胰腺的晚期升结肠癌（AACC）来说，这是唯一的治愈方法。有一些相关报道，尤其是来自日本的。在此，我们报告一例极为罕见的患者，该患者因AACC直接侵犯十二指肠和肝脏而接受了RHPD手术，并描述了患者在整块切除术后的长期生存情况。
患者为一名76岁男性，主要主诉为右腹痛，且在过去一个月体重减轻了12公斤。结肠镜检查显示升结肠有一个2型肿瘤环绕肠壁。术前计算机断层扫描显示升结肠有一个12厘米的肿块病变，肠壁增厚，且已侵犯十二指肠第二部。微卫星高度不稳定/错配修复缺陷（MSI-H/dMMR）为阴性。由于术前诊断为临床T4b（十二指肠和肝脏）N1bM0 IIIc期癌症，故采用开放手术进行RHPD和部分肝切除术。尽管在患者术后过程中观察到2级不良反应，即胃排空延迟，但通过保守治疗患者病情得到缓解。术后第17天开始经口进食，术后第25天出院。给予卡培他滨联合奥沙利铂辅助化疗6个月。苏木精-伊红染色显示为中度分化腺癌，侵犯十二指肠和肝脏。患者被诊断为病理T4b（十二指肠和肝脏）N1bM0 IIIc期癌症。术后40个月未发现复发。
对于累及十二指肠的AACC，唯一的治愈性治疗方法是整块RHPD。在此，我们描述了一例通过整块切除确保R0切除从而实现长期生存的病例。
