Twenty-one patients (91.3%) had reductions in tumor volume after neoadjuvant treatment, and 13 patients (56.5%) had grade 3–4 toxicity.
#Hepatic flexture resection trial#
Primary outcome measures of this stage II trial were feasibility, safety, tolerance and efficacy of neoadjuvant treatment.Īll 23 patients received neoadjuvant chemotherapy and underwent surgery. Complete mesocolic excision was scheduled 2–6 weeks after completion of neoadjuvant treatment and followed by a further 6 cycles of FOLFOXIRI or XELOX. Patients with clinical stage IIIb colon cancer received a perioperative triple chemotherapy regimen (oxaliplatin 85 mg/m² and irinotecan 150 mg/m², combined with folinic acid 200 mg, 5-fluorouracil 500 mg bolus and then 2,400 mg/m² by 44 h infusion or capecitabine 1 g/m² or S-1 40–60 mg b.i.d orally d 1–10, repeated at 2-week intervals) for 4 cycles. This study aims to investigate the feasibility, safety and efficacy of triplet regimen of neoadjuvant chemotherapy in patients with locally advanced resectable colon cancer. Multidisciplinary teamwork and multimodality treatment alternatives may improve the results. This procedure may result in long-term survival with acceptable morbidity and mortality rates. The reasonable option for this patient is to perform en bloc pancreaticoduodenectomy and right colectomy. In locally advanced right colon tumors, all adhesions should be considered as malign invasion and separation should not be done. One patient lived 70 months after multivisceral resection and underwent cytoreductive surgery and total pelvic exenteration during the follow-up period. Median disease-free survival time was 24.5 months and median overall survival time was 42.1 (range: 4.5–70.4) months in our series. No major morbidities or perioperative mortalities were observed. Between 20, 5 patients underwent en bloc multivisceral resection. The aim of this study is to report our experience on en bloc right colectomy with pancreaticoduodenectomy for locally advanced right colon cancers. Previously, this challenging procedure was associated with high morbidity and mortality however, today, this procedure can be done more safely in experienced centers. Direct invasion of the duodenum and pancreas necessitates an en bloc resection. Locally advanced right colon cancer may invade adjacent tissue and organs. Moreover, the minimally invasive approach not only shortened the hospital stay and reduced blood loss and pain, it also guaranteed successful treatment of the radiofrequency therapy in our case. Reasonable surgical design and effective translational therapy allowed radical resection via laparoscopy. At present, our patient continues to receive adjuvant chemotherapy with XELOX and an oncology follow-up. The patient recovered well without any complications and was discharged on the 25th postoperative day, with a total hospital stay of 41 d. No cancer cells were found at all surgical margins and in all 40 lymph nodes were examined histologically. Following the Becker criteria for tumour regression grading (TRG),(5) the tumour was assessed as TRG3 grade. The entire tumour was eventually removed from the abdominal wound at the stoma site, and an ileostomy was formed to prevent anastomotic leakage associated with the targeted drug.(4) Pathological examination revealed a moderately differentiated adenocarcinoma that directly invaded the entire duodenum (T4bN0M1a). It was found ideal for most complex pancreaticojejunostomy procedures to align the longitudinal axis of the instrument used perpendicular to the pancreas. Upward separation was continued along the caudal approach, and PD was subsequently completed. First, a conventional laparoscopic radical RC was completed, and the location and depth of pancreaticoduodenal invasion was evaluated. Radiofrequency therapy for a liver lesion was planned to achieve radical treatment.
#Hepatic flexture resection plus#
After five courses of oxaliplatin plus capecitabine (XELOX) and three courses of bevacizumab transformation, RC+PD was performed. This video presents the first case of pure laparoscopic RC+PD via caudal approach after chemotherapy and targeted drug translational treatment.Ī 73-year-old female patient was diagnosed with hepatic flexure carcinoma that infiltrated the pancreas and duodenum with a single liver metastasis. Laparoscopic-assisted or open extended right hemicolectomy (RC) plus pancreaticoduodenectomy (PD) has recently been reported.(1, 2) A less invasive alternative with better surgical outcomes is pure laparoscopic surgery,(3) which is expected to resolve impaired wound healing caused by targeted drugs that can delay subsequent systemic therapies.
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