L. M. Daniels1, M. Khalili1, N. Grandhi1, A. Thandoni1, F. Burg1, L. Holleran1, E. M. Gleeson1, W. F. Morano1, W. B. Bowne1 1Drexel University College Of Medicine,Surgery,Philadelphia, Pa, USA
Introduction:
Pancreaticoduodenectomy (PD) in conjunction with a right hemicolectomy (RH) has been performed to treat locally advanced right colon cancers (LARCC). Herein, we characterize clinicopathologic factors and evaluate outcomes of en bloc PD and RH for LARCC.
Methods:
A systematic review of the world literature was conducted on PubMed using MeSH search terms [“pancreaticoduodenectomy” OR “pancreas/surgery” OR “duodenum/surgery” OR “colectomy”] AND [“colonic neoplasms”]. Data was extracted from patients who specifically underwent an en bloc PD and RH for primary colon cancer. Exclusion criteria included articles not published in English, those from which individual patient data could not be extrapolated, patients without primary colonic malignancy, and those with metastatic disease. Factors investigated included patient presentation, surgical and pathological parameters, postoperative complications, and disease recurrence and survival. Standard statistical tests were used.
Results:
Search yielded 28 articles from 1980-2017 with a cohort of 106 patients, including one case from our institution. Most patients were male (62.1%) with median age 58 years (range 34-83). Surgical procedures performed included en bloc RH with PD (n=91, 85.8%) and en bloc RH with pylorus-preserving pancreaticoduodenectomy (PPDP), (n=15, 14.2%). Median follow up was 21 months. R0 resection was reported in 63 patients. Of patients who experienced one or more complications (n=63, 52.4%), the most common included pancreatic fistula (n=15, 23.8%) and delayed gastric emptying (n=11, 17.5%). Fifty-three patients (50%) reportedly experienced no recurrence, 27 (25.5%) recurred, and 26 (24.5%) cases did not specify. Median recurrence free survival was not met. The average time to recurrence was 18.6 months; 60% of patients were disease free at 5 years. Median survival was 168 months. Survival after resection was 74.1% at 2 years and 63.2% at 5 years (Figure 1). Overall survival was improved with earlier diagnosis (IIC versus IIIC, p<0.005) and younger age at time of resection (<60 versus ≥ 60, p=0.031). Patients with stage IIC had an 84.9% 5 year survival versus 46.4% for patients with stage IIIC. Five year survival for patients <60 years was 70.9% versus 62.9% for patients ≥ 60 years. There were 2 postoperative mortalities.
Conclusion:
These data demonstrate that en bloc PD and RH is rarely performed, yet can be a safe procedure and potential treatment option in patients with LARCC. Patients less than 60 years of age and patients with less advanced disease had significantly improved outcomes.
