Resection for cure of carcinoma of the colon directly invading the duodenum or pancreatic head.

BACKGROUND: Approximately 10 percent of carcinomas of the colon and rectum adhere to adjacent organs or structures, which rarely include the duodenum or pancreas.

STUDY DESIGN: To confirm the importance of aggressive operative management in patients with locally advanced carcinoma of the colon invading the duodenum or pancreatic head, we reviewed the medical records of 12 patients who underwent an extended resection for a right-sided carcinoma of the colon involving the duodenum or the pancreatic head, or both.

RESULTS: All patients underwent an extended right hemicolectomy, including en bloc pancreaticoduodenectomy (seven patients) or lateral duodenectomy (five patients). The mean operative blood loss was 627 mL, and there were no postoperative deaths. Malignant invasion of the duodenum or pancreas was confirmed in all 12 patients, but only three (25 percent) had lymph node metastases. The median survival period for all 12 patients was 32 months. However, the median survival period for the eight patients still alive without recurrent or metastatic disease was 42 months.

CONCLUSIONS: In patients with locally advanced carcinoma of the colon involving the duodenum or pancreatic head long-term survival can be achieved by en bloc resection.