Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum

• Published in: Surgical oncology 2014-06, Vol.23 (2), p.92-98
• Main Authors: Cirocchi, Roberto, Partelli, Stefano, Castellani, Elisa, Renzi, Claudio, Parisi, Amilcare, Noya, Giuseppe, Falconi, Massimo
• Format: Article
• Language: English
• Subjects: Cancer; Cancer therapies; Colectomy; Colon; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Drug therapy; Duodenal Neoplasms - pathology; Duodenal Neoplasms - surgery; Duodenum; Gender; Hematology, Oncology and Palliative Medicine; Histology; Humans; Mortality; Neoplasm Invasiveness; Neoplasms, Multiple Primary - pathology; Neoplasms, Multiple Primary - surgery; Pancreas; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Patients; Postoperative period; Prognosis; Studies; Surgery
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2014.03.003

Abstract Introduction Pancreatic or duodenal invasion by locally advanced right colon cancer is an unusual event whose management still represents a surgical challenge. This review aims to compare results of limited vs. extended resection in case of primary right colon cancer invading pancreas and/or duodenum. Methods A systematic search in Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. All trials describing the surgical treatment of right colon cancer invading pancreas and/or duodenum were considered. A data extraction sheet was developed, based on the Cochrane Consumers and Communication Review Group's data extraction template. Results 5-years overall survival was 52% after en bloc pancreaticoduodenectomy plus right hemicolectomy vs. 0 and 25% in case of duodenal resection with correction by direct suture or pedicled ileal flap, respectively. 30-day postoperative morbidity rate was slightly higher after en block resections (12.8%) with respect to duodenal local resection and direct suture or pedicled ileal flap repair (0 and 12.2%, respectively). After extended resection the rate of pancreatico-jejunal anastomotic leakage was 7.7%. Conclusions In patients with right colon cancer extended to the pancreas and/or duodenum surgical multivisceral resection is suggested when complete tumour removal (R0) is achievable. Even though no significant differences in postoperative morbidity and mortality have been shown, 5 y OS has improved in extended resections as compared to duodenal local resection with defect repair either by direct suture or by a pedicled ileal flap.