En bloc Right Hemicolectomy with Pancreaticoduodenectomy for Advanced Ascending Colon Cancer

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.