Roberto Cirocchi1, Stefano Partelli2, Elisa Castellani3, Claudio Renzi4, Amilcare Parisi1, Giuseppe Noya3, Massimo Falconi2. 1. Department of Digestive and Liver Surgery Unit, St Maria Hospital, Terni, Italy. 2. Pancreatic Surgery Unit, Università Politecnica delle Marche, Ancona, Italy. 3. Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. 4. Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: renzicla@virgilio.it.
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.
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.
Authors: Jennifer W Harris; Jeremiah T Martin; Erin C Maynard; Patrick C McGrath; Ching-Wei D Tzeng Journal: HPB (Oxford) Date: 2015-07-30 Impact factor: 3.647