Pancreatic head resection for invasive colon cancer--apropos of a case

Despite the possibilities for early detection of colon cancer, some patients present with locally advanced cancer with invasion of adjacent organs. A case of right colonic cancer with infiltration of the duodenum and pancreas that was treated with hemicolectomy and duodeno-pancreatectomy (DP) en bloc is reported.

A 76-year-old man was admitted to the local hospital due to anaemia, loss of weight and worsening clinical condition. Clinical examination, including upper and lower intestinoscopy and computed tomography of the abdomen, revealed right-sided colonic cancer with infiltration of the duodenum and the pancreas causing a bleeding duodenal ulcer that was the origin of the anaemia. The patient was transferred to our hospital for surgical therapy. The primary colon cancer seemed to be resectable without suspicion of hepatic metastases or peritoneal seeding, and a right-sided hemicolectomy with en bloc duodeno-pancreatectomy was carried out. Histopathological examination classified the tumour as pT4 pN1 (3/24) M0 G3 R0 according to stage III of the UICC classification. The patient recovered uneventfully.

This case demonstrates that even common diseases such as colonic cancer may require a careful preoperative diagnosis so that a patient with a locally advanced tumour may be transferred to a specialist centre. With colorectal carcinoma, monobloc resection is standard, but a monobloc hemicolectomy on the right side and pancreatic head resection can only be performed in hospitals having sufficient expertise in pancreatic surgery.