En bloc resection of right-sided colonic adenocarcinoma with adjacent organ invasion.
BACKGROUND
Right-sided colon cancers that invade the adjacent organs are often missed on preoperative imaging. These patients are often considered unresectable at laparotomy as the surgeon is not prepared for en bloc resections. A few centers have reported extended survival after en bloc resection in such tumors. We therefore decided to evaluate the outcome of our patients after en bloc right hemicolectomy.


METHODS
The records of all patients who underwent en bloc resection of adjacent organs for right colon cancers were analyzed.


RESULTS
Between 1992 and 2004, 11 patients had an en bloc right hemicolectomy for right-sided colon cancer. There were ten males and one female with a mean age of 44 years (35-80 years). All patients had anaemia at presentation and most had weight loss and a fixed palpable lump. Preoperative CT scan was able to detect adjacent organ infiltration in nine patients. Six patients had an en bloc pancreaticoduodenectomy, three patients had en bloc local excision of duodenal wall, one patient had en bloc resection of segments 5 and 6 of the liver and one patient had en bloc distal gastrectomy. There was one operative mortality after an en bloc pancreaticoduodenectomy. The median disease-free survival was 54 months.


CONCLUSIONS
Right-sided colon cancers that invade adjacent organs in the absence of distant spread may be a subset of tumors that behave in a locally aggressive manner without causing hematogenous spread. En bloc resection of these tumors is possible, in select centers, with low mortality and morbidity and extended survival.
Kapoor
Sorabh
S
Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Room No 1007, 1st floor, PC block, Ansari Nagar, New Delhi, 110029, India. sorabhkapoor@hotmail.com
Das
Biswabasu
B
Pal
Sujoy
S
Sahni
Peush
P
Chattopadhyay
Tushar K
TK
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010180:Pancreatectomy; D012189:Retrospective Studies