Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen
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 wit...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-021-00351-6 |
| _version_ | 1818649135909175296 |
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| author | Joe-Bin Chen Shao-Ciao Luo Chou-Chen Chen Cheng-Chung Wu Yun Yen Chuan-Hsun Chang Yun-An Chen Fang-Ku P’eng |
| author_facet | Joe-Bin Chen Shao-Ciao Luo Chou-Chen Chen Cheng-Chung Wu Yun Yen Chuan-Hsun Chang Yun-An Chen Fang-Ku P’eng |
| author_sort | Joe-Bin Chen |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-17T01:29:31Z |
| format | Article |
| id | doaj.art-33edaabbbfa840aeb094ade2c7db1480 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-17T01:29:31Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-33edaabbbfa840aeb094ade2c7db14802022-12-21T22:08:37ZengBMCWorld Journal of Emergency Surgery1749-79222021-02-011611910.1186/s13017-021-00351-6Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomenJoe-Bin Chen0Shao-Ciao Luo1Chou-Chen Chen2Cheng-Chung Wu3Yun Yen4Chuan-Hsun Chang5Yun-An Chen6Fang-Ku P’eng7Department of Surgery, Taichung Veterans General HospitalDepartment of Surgery, Taichung Veterans General HospitalDepartment of Surgery, Taichung Veterans General HospitalDepartment of Surgery, Taichung Veterans General HospitalCancer Translational Research Center, Taipei Medical UniversityDepartment of Surgery, Cheng Hsin General HospitalDepartment of Pathology, Taichung Veterans General HospitalDepartment of Surgery, Taichung Veterans General HospitalAbstract 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.https://doi.org/10.1186/s13017-021-00351-6Locally advanced colon carcinomaPancreaticoduodenectomyColectomyAcute abdomen |
| spellingShingle | Joe-Bin Chen Shao-Ciao Luo Chou-Chen Chen Cheng-Chung Wu Yun Yen Chuan-Hsun Chang Yun-An Chen Fang-Ku P’eng Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen World Journal of Emergency Surgery Locally advanced colon carcinoma Pancreaticoduodenectomy Colectomy Acute abdomen |
| title | Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen |
| title_full | Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen |
| title_fullStr | Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen |
| title_full_unstemmed | Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen |
| title_short | Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen |
| title_sort | colo pancreaticoduodenectomy for locally advanced colon carcinoma feasibility in patients presenting with acute abdomen |
| topic | Locally advanced colon carcinoma Pancreaticoduodenectomy Colectomy Acute abdomen |
| url | https://doi.org/10.1186/s13017-021-00351-6 |
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