Colo-pancreaticoduodenectomy for Locally Advanced Colon Carcinoma- Feasibility in Patients Manifesting as Acute Abdomen

Abstract BackgroundThe only curative option for locally advanced colon carcinoma invading duodenum and/or pancreatic head is the en-bloc right hemicolectomy plus pancreaticoduodenectomy (PD), so called colo-pancreaticoduodenectom (cPD). Patients with this disease may present as an acute abdomen. Emergent PD often has high postoperative morbidity and mortality. Here we aimed to evaluate the feasibility and outcomes of emergent cPD for such patients of advanced colon carcinoma, manifesting as life-threatening acute abdominal conditions.Patients and MethodsWe retrospectively review of 4,793 patients who underwent curative colectomy for the treatment of colorectal cancer in the period from 1993 and 2017. Among these patients, 30 had locally advanced right colon cancer and underwent a cPD. The cPD of 11 patients were performed in acute abdomen conditions (bowel obstruction 6, perforation 3, tumor bleeding 2). Selection criteria for emergent cPD were: (1) age ≦60 years, (2) body mass index <35 kg/m2, (3) no poorly-controlled comorbidities, and (4) perforation time ≤6 hours. Three patients who failed to meet these criteria received non-emergent cPD after a life-saving diverting ileostomy, and cPD was performed three months later. The patients clinicopathological characteristics, the early and long-term postoperative outcomes were compared between emergent cPD (e-group, n=11) and non-emergent cPD (non-e group, n=19). After cPD, staged pancreaticojejunostomy (PJ) was performed in all e-group, and on 15 of 19 non-e group patients.ResultsThe non-e group had significant higher patient age and higher incidence of associated comorbidities, while clinicopathological characteristics were otherwise similar. None of the patients in the two groups succumbed from cPD. Postoperative complication rate was 63.6% in the e-group, and 42.1% in the non-e group (p=0.449). The 5-year overall survival rate was 15.9% in the e-group, and 52.6% in the non-e-group (p=0.192).ConclusionsIn highly selected patients, emergent cPD is feasible by cooperation of experienced colorectal and pancreatic surgeons. The early and long-term outcomes of emergent and were similar to those after non-emergent cPD.