title: Management of patients with carcinoma of the right colon invading the duodenum or pancreatic head.
abstract: BACKGROUND
  Only few case series have been published about locally advanced carcinoma of the right colon invading the duodenum or pancreas (CRCDP). We report results of a retrospective study about this rare entity focusing on management and prognosis.
  
  
  METHODS
  We reviewed the complete data of patients operated for CRCDP between 1988 and 2005 in four French digestive-surgery departments.
  
  
  RESULTS
  Fifteen patients were managed [12 men, 3 women, mean age 63 years (43-86)]. These patients underwent attempted curative en bloc resection including right colectomy: 12 were treated by partial duodenectomy (tumours involving only a part of the duodenum); 3 were treated by pancreaticoduodenectomy. All tumours resected had clear resection margins (R0). About 53% of patients had hepatic metastases, duodenocolic fistula, carcinomatosis, abscess or perforation at presentation. Surgery was performed in emergency in 26% of cases. About 20% of patients had serious postoperative complications (heart failure, bile duct necrosis, septic shock), and three other patients had postoperative anastomotic leaks. No patient experienced duodenal fistula after partial duodenectomy. The mean median survival in resected patients was 22 months (0-122). Overall 1 and 3 years survival were 68% (n=7) and 56% (n=4). Despite clear resection margins in all patients, 26% of patients developed recurrence (duodenal wall resection n=3; pancreaticoduodenectomy n=1).
  
  
  CONCLUSIONS
  Morbidity and mortality after colectomy and en bloc partial duodenectomy or pancreaticoduodenectomy are high but in selected cases could offer prolonged survival. Aggressive surgery including major resection should be performed to obtain clear resection margins even in case of complicated forms.
authors.affiliation: Digestive Medico-Surgical Department, CHU Nord, Amiens, place Victor Pauchet, 80054, Amiens Cedex 01, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.forename: François
authors.initials: F
authors.lastname: Mauvais
authors.forename: Olivier
authors.initials: O
authors.lastname: Bréhant
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dumont
authors.forename: Denis
authors.initials: D
authors.lastname: Chatelain
authors.forename: Thierry
authors.initials: T
authors.lastname: Yzet
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Joly
authors.forename: Benoit
authors.initials: B
authors.lastname: Lefebure
authors.forename: Sushil
authors.initials: S
authors.lastname: Deshpande
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Arnaud
authors.forename: Pierre
authors.initials: P
authors.lastname: Verhaeghe
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003082:Colectomy / Q000009:adverse effects; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000473:pathology / Q000601:surgery*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome