ĐIỀU TRỊ PHẪU THUẬT UNG THƯ ĐẠI TRÀNG PHẢI XÂM LẤN ĐẦU TỤY TÁ TRÀNG

Abstract

Introduction: Locally advanced right colon cancer invading duodenum and/or head of pancreas is rare condition (11-28%). The surgical procedure aim at negative resection margin (R0 resection)  that consisting of right hemicolectomy plus pancreatic duodenectomy (En bloc resection) or right hemicolectomy plus duodenal segmentectomy incase of tumor invading duodenum alone which could be reduce the mortality and morbility. On the other hand when patients undergo the bypass  palliative  or incomplete surgery (R1-2), the mean survival period is 9 to 11 months.We therefore conduct our retrospective study aim at evaluation the clinical features and the resuls of surgical management for locally advanced right colon cancer invading duodenum and/or pancreatic head. Patient and methods: Retrospective study. Time: 2020-2023. Results: 7 patients, Female 6/7 (85.7%), Male 1/7 (14,3%), mean age 58,3 year old. All patients had subobstruction, 42,8% of tumors were palpable; Abdominal CT scan could detect all right sided colon tumors but unable to detect  the tumor invasion  or  perfogation  to duodenum and/or head of pancreas. Colonoscopy revealed 6/7 circumferential tumor in right colon with stricture of lumen. Upon laparotomy, there were 3 right colon cancer perforated to duodenum, 2 others invaded to inferior flexure of duodenum; 2 others tumor invaded duodenum and head of pancreas with liver metastasis. Surgical procedure performed: For 1 patient, right hemi colectomy plus  DII duodenal segmentectomy and antrectomy with duodenostomy for compression (colon tumor perforated to DII); For 2 other patients, right hemicolectomy plus DII-DIII duodenal segmentectomy with end to end anastomosis (2 layers), antrectomy and duodenostomy for compression. For 2 others, transversal sutures of inferior duodenal flexure with gastrojejunostomy plus right hemicolectomy were performed. For 2 others patients with liver metastasis and right colon cancer invading duodenum and head of pancreas, operations were  right hemicolectomy and gastrojejunostomy (bypass). There  were no death per and post operation. Complication: 2 small volume fistulas healing by medical treatment. 2 other had infection of incisional sites. Median hospital stays 10,7 days (7-18 days). T stage T4aNoM1: 2 patients; T4bN0M0: 5 patients. 1 patient refused chemotherapy. Follow up time 4 months to 24 months. Conclusion: The locally advanced right colon cancer invading duodenum and/or head of pancreas could be radically operated. The surgical procedure consisting of right hemicolectomy plus duodenopancreatectomy that could have elevated mortality and morbidity especially in patients with high perioperative risks and comorbidities. The right hemi colectomy plus duodenal segmentectomy or limited duodenal resection show promising results if the margin of at least 1 cm from the invaded area are respected (when tumor invading duodenum alone) and could reduce the mortality and morbidity. The bypass or incomplete surgery (R1-2 resection) should be reserved to patent with malignant distal spread.