Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2021

Open Access 01-12-2021 | Acute Abdomen | Research article

Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen

Authors: Joe-Bin Chen, Shao-Ciao Luo, Chou-Chen Chen, Cheng-Chung Wu, Yun Yen, Chuan-Hsun Chang, Yun-An Chen, Fang-Ku P’eng

Published in: World Journal of Emergency Surgery | Issue 1/2021

Login to get access

Abstract

Background

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.

Methods

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/m2, (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.

Results

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).

Conclusions

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.
Literature
1.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34.PubMed
2.
Chiang CJ, Lo WC, Yang YW, You SL, Chen CJ, Lai MS. Incidence and survival of adult cancer patients in Taiwan, 2002-2012. J Formos Med Assoc. 2016;115(12):1076–88.PubMedCrossRef
3.
Eldar S, Kemeny MM, Terz JJ. Extended resections for carcinoma of the colon and rectum. Surg Gynecol Obstet. 1985;161(4):319–22.PubMed
4.
Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg. 2002;235(2):217–25.PubMedPubMedCentralCrossRef
5.
Perysinakis I, Nixon A, Katopodi A, Tzirakis E, Georgiadou D, Avlonitis S, et al. Long term survival after right hemicolectomy and pancreatoduodenectomy for locally advanced colonic cancer: Case report. Int J Surg Case Rep. 2011;2(7):206–7.PubMedPubMedCentralCrossRef
6.
Agalar C, Canda AE, Unek T, Sokmen S. En Bloc Pancreaticoduodenectomy for Locally Advanced Right Colon Cancers. Int J Surg Oncol. 2017;2017:5179686.PubMedPubMedCentral
7.
Berrospi F, Celis J, Ruiz E, Payet E. En bloc pancreaticoduodenectomy for right colon cancer invading adjacent organs. J Surg Oncol. 2002;79(3):194–7 discussion 8.PubMedCrossRef
8.
Cirocchi R, Partelli S, Castellani E, Renzi C, Parisi A, Noya G, et al. Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum. Surg Oncol. 2014;23(2):92–8.PubMedCrossRef
9.
Curley SA, Evans DB, Ames FC. Resection for cure of carcinoma of the colon directly invading the duodenum or pancreatic head. J Am Coll Surg. 1994;179(5):587–92.PubMed
10.
Fuks D, Pessaux P, Tuech JJ, Mauvais F, Brehant O, Dumont F, et al. Management of patients with carcinoma of the right colon invading the duodenum or pancreatic head. Int J Color Dis. 2008;23(5):477–81.CrossRef
11.
Iwasaki Y, Moriya Y, Miyake H, Akasu T, Fujita S. En bloc surgery for colon cancer: report of a case. Surg Today. 2000;30(2):191–4.PubMedCrossRef
12.
Izumi Y, Ueki T, Naritomi G, Akashi Y, Miyoshi A, Fukuda T. Malignant duodenocolic fistula: report of a case and considerations for operative management. Surg Today. 1993;23(10):920–5.PubMedCrossRef
13.
Kama NA, Reis E, Doganay M, Gozalan U, Yasti C. Radical surgery of colon cancers directly invading the duodenum, pancreas and liver. Hepatogastroenterology. 2001;48(37):114–7.PubMed
14.
Kaneda Y, Noda H, Endo Y, Kakizawa N, Ichida K, Watanabe F, et al. En bloc pancreaticoduodenectomy and right hemicolectomy for locally advanced right-sided colon cancer. World J Gastrointest Oncol. 2017;9(9):372–8.PubMedPubMedCentralCrossRef
15.
Khalili M, Daniels L, Gleeson EM, Grandhi N, Thandoni A, Burg F, et al. Pancreaticoduodenectomy outcomes for locally advanced right colon cancers: A systematic review. Surgery. 2019;166(2):223–9.PubMedCrossRef
16.
Kimchi ET, Nikfarjam M, Gusani NJ, Avella DM, Staveley-O'Carroll KF. Combined pancreaticoduodenectomy and extended right hemicolectomy: outcomes and indications. HPB (Oxford). 2009;11(7):559–64.CrossRef
17.
Koea JB, Conlon K, Paty PB, Guillem JG, Cohen AM. Pancreatic or duodenal resection or both for advanced carcinoma of the right colon: is it justified? Dis Colon Rectum. 2000;43(4):460–5.PubMedCrossRef
18.
Li D, Si X, Wan T, Zhou Y. A pooled analysis of en bloc right hemicolectomy with pancreaticoduodenectomy for locally advanced right-sided colon cancer. Int J Color Dis. 2018;33(6):819–22.CrossRef
19.
Loutfy A, Vasani S. Locally advanced colon cancer resulting in en bloc right hemicolectomy and pancreaticoduodenectomy: case report and review of literature. J Surg Case Rep. 2018;2018(5):rjy100.PubMedPubMedCentralCrossRef
20.
Marsman EM, de Rooij T, van Eijck CH, Boerma D, Bonsing BA, van Dam RM, et al. Pancreatoduodenectomy with colon resection for cancer: a nationwide retrospective analysis. Surgery. 2016;160(1):145–52.PubMedCrossRef
21.
Meyer A, Behrend M. Pancreatic head resection for invasive colon cancer--apropos of a case. Anticancer Res. 2007;27(3B):1733–6.PubMed
22.
Noda H, Kato T, Kamiyama H, Toyama N, Konishi F. En bloc right hemicolectomy and pancreaticoduodenectomy with superior mesenteric vein resection for advanced right-sided colon cancer. Clin J Gastroenterol. 2010;3(5):259–61.PubMedCrossRef
23.
Yoshimi F, Asato Y, Kuroki Y, Shioyama Y, Hori M, Itabashi M, et al. Pancreatoduodenectomy for locally advanced or recurrent colon cancer: report of two cases. Surg Today. 1999;29(9):906–10.PubMedCrossRef
24.
Zhang J, Leng JH, Qian HG, Qiu H, Wu JH, Liu BN, et al. En bloc pancreaticoduodenectomy and right colectomy in the treatment of locally advanced colon cancer. Dis Colon Rectum. 2013;56(7):874–80.PubMedCrossRef
25.
Zhu R, Grisotti G, Salem RR, Khan SA. Pancreaticoduodenectomy for locally advanced colon cancer in hereditary nonpolyposis colorectal cancer. World J Surg Oncol. 2016;14(1):12.PubMedPubMedCentralCrossRef
26.
Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220(4):530–6.PubMedCrossRef
27.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349(22):2117–27.PubMedCrossRef
28.
Fuks D, Piessen G, Huet E, Tavernier M, Zerbib P, Michot F, et al. Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg. 2009;197(6):702–9.PubMedCrossRef
29.
Gulla A, Tan WP, Pucci MJ, Dambrauskas Z, Rosato EL, Kaulback KR, et al. Emergent pancreaticoduodenectomy: a dual institution experience and review of the literature. J Surg Res. 2014;186(1):1–6.PubMedCrossRef
30.
31.
Lupascu C, Trofin A, Zabara M, Vornicu A, Cadar R, Vlad N, et al. Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery. Gastroenterol Res Pract. 2017;2017:2036951.PubMedPubMedCentralCrossRef
32.
McArdle CS, McMillan DC, Hole DJ. The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg. 2006;93(4):483–8.PubMedCrossRef
33.
Tsai CY, Lai BR, Wang SY, Liao CH, Liu YY, Kang SC, et al. The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients. World J Emerg Surg. 2017;12:21.PubMedPubMedCentralCrossRef
34.
You L, Zhao W, Hong X, Ma L, Ren X, Shao Q, et al. The effect of body mass index on surgical outcomes in patients undergoing pancreatic resection: a systematic review and meta-analysis. Pancreas. 2016;45(6):796–805.PubMedCrossRef
35.
Hasegawa K, Kokudo N, Sano K, Seyama Y, Aoki T, Ikeda M, et al. Two-stage pancreatojejunostomy in pancreaticoduodenectomy: a retrospective analysis of short-term results. Am J Surg. 2008;196(1):3–10.PubMedCrossRef
36.
Miyagawa S, Makuuchi M, Kawasaki S, Ogiwara M. Second-stage pancreatojejunostomy following pancreatoduodenectomy in high-risk patients. Am J Surg. 1994;168(1):66–8.PubMedCrossRef
37.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedPubMedCentralCrossRef
38.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161(3):584–91.PubMedCrossRef
39.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.PubMedCrossRef
40.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.PubMedCrossRef
41.
Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149(5):680–8.PubMedCrossRef
42.
Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. (Eds.). AJCC Cancer Staging Manual (8th edition). Springer International Publishing: American Joint Commission on Cancer; 2017. p. 251–74.
43.
Wu CC, Hwang CR, Yeh DC, Hwang YC, Liu TJ, P'Eng FK. Treatment for dehiscence of pancreaticojejunostomy after pancreaticoduodenectomy: is resection of the residual pancreas necessary? Hepatogastroenterology. 1996;43(7):271–4.PubMed
44.
Yeh DC, Wu CC, Liu TJ, P'Eng FK. Management of acute pancreatitis: results of a 15-year experience in Taiwan. J Hepato-Biliary-Pancreat Surg. 2001;8(3):204–10.CrossRef
45.
Luo SC, Cheng SB, Wu CC, Huang CC, Lin YL, P'Eng FK. Embedding fistulojejunostomy: an easy and secure technique for refractory external pancreatic fistula. Asian J Surg. 2018;41(2):143–7.PubMedCrossRef
46.
Wu CC, Chen JT, Ho WL, Yeh DC, Tang JS, Liu TJ, et al. Liver resection for hepatocellular carcinoma in octogenarians. Surgery. 1999;125(3):332–8.PubMedCrossRef
47.
Wu FH, Shen CH, Luo SC, Hwang JI, Chao WS, Yeh HZ, et al. Liver resection for hepatocellular carcinoma in oldest old patients. World J Surg Oncol. 2019;17(1):1.PubMedPubMedCentralCrossRef
Metadata
Title
Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen
Authors
Joe-Bin Chen
Shao-Ciao Luo
Chou-Chen Chen
Cheng-Chung Wu
Yun Yen
Chuan-Hsun Chang
Yun-An Chen
Fang-Ku P’eng
Publication date
01-12-2021
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2021
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-021-00351-6

Other articles of this Issue 1/2021

World Journal of Emergency Surgery 1/2021 Go to the issue

Research article

Periappendiceal fat-stranding models for discriminating between complicated and uncomplicated acute appendicitis: a diagnostic and validation study

Review

Anorectal emergencies: WSES-AAST guidelines

Letter to the Editor

A pandemic recap: lessons we have learned

Research article

Variation in use of damage control laparotomy for trauma by trauma centers in the United States, Canada, and Australasia

Research article

Emergency angiography for trauma patients and potential association with acute kidney injury

Research article

The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access