[Surgical treatment and prognosis of cancer of hepatic flexure of colon invading the duodenum in 65 patients].
OBJECTIVE
To discuss surgical treatment of right colon carcinoma of hepatic flexure invading the duodenum.


METHODS
Sixty-five patients with right colon carcinoma of hepatic flexure invading the duodenum, treated in our department from 1987 to 2007, were included in this study. Their clinicopathological data were retrospectively reviewed and analyzed. All the cases were divided into three types (local invasion, regional invasion, and cancer with internal fistula) according to duodenal defect, including local invasion (< 2.0 cm), wide invasion (> 2.0 cm) and the presence of internal fistula.


RESULTS
25 patients with local invasion underwent en bloc resection of the duodenal wall. Pedicled ileal flap was used to cover the large duodenal defect measuring 2.0 - 3.0 cm in 5 patients. Dudenojejunostomy was used to reconstruct the large defect measuring more than 5 cm in 3 patients. Conservative resection of right-sided colon was performed in 18 patients with wide invasion. 4 patients underwent pancreaticoduodenectomy combined with right hemicolectomy for colon cancer involving the pancreatic head. 10 underwent duodenal diverticularization. One patient with anastomotic leakage healed within 3 weeks. Other patients were cured without postoperative complications. The total 3-year and 5-year survival rates after surgery were 53.8% and 9.2%, respectively.


CONCLUSIONS
The surgical procedure to be performed is usually decided according to the cancer location, extent, and duodenal defect and invasion, which are important for prolonging life time, improving of quality of life and prognosis in these patients.
Yang
Wei-liang
WL
Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China. wlyang_2008@163.com
Yan
Chao-qi
CQ
Zhang
Hao-gang
HG
Wang
Fu-jing
FJ
Ma
Yu-lin
YL
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods; D044682:Colon, Ascending / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate