• colon cancer
• en bloc resection
• pancreaticoduodenectomy
• right hemicolectomy

• Colectomy
• Neoadjuvant therapy
• Pancreatic neoplasms
• Pancreaticoduodenectomy

• colorectal cancer
• gastric cancer
• multivisceral resection
• pancreatic cancer
• pancreaticoduodenectomy

• Humans
• Pancreaticoduodenectomy/methods
• Pancreaticoduodenectomy/adverse effects
• Stomach Neoplasms/surgery
• Treatment Outcome
• Prognosis
• Colonic Neoplasms/surgery

• colectomy
• colon cancer
• long-term outcomes
• morbidity
• mortality
• pancreatic cancer
• pancreaticoduodenectomy

• Gastrointestinal stromal tumours
• Imatinib
• Partial gastrectomy

• Male
• Female
• Humans
• Middle Aged
• Gastrointestinal Stromal Tumors/pathology
• Antineoplastic Agents/therapeutic use
• Ghana
• Neoplasm Recurrence, Local
• Gastrointestinal Neoplasms/therapy
• Abdominal Pain

• Case study
• Colonic liver cancer
• Duodenum
• Duodenum-jejunum Roux-en-Y anastomosis
• Tumor infiltration

• advanced colon cancer
• en bloc resection
• hemicolectomy
• multivisceral resection
• pancreaticoduodenectomy

As one of the major abdominal operations, pancreaticoduodenectomy (PD) involves many organs. The operation is complex, and the scope of the operation is large, which can cause significant trauma in patients. The operation has a high rate of complications. Pancreatic leakage is the main complication after PD. When pancreatic leakage occurs after PD, it can often lead to abdominal bleeding and infection, threatening the lives of patients. One study found that pancreatic leakage was affected by many factors including the choice of pancreaticojejunostomy method which can be well controlled.

To investigate the choice of operative methods for pancreaticojejunostomy and to conduct a multivariate study of pancreatic leakage in PD.

A total of 420 patients undergoing PD in our hospital from January 2014 to March 2019 were enrolled and divided into group A (n = 198) and group B (n = 222) according to the pancreatointestinal anastomosis method adopted during the operation. Duct-to-mucosa pancreatojejunostomy was performed in group A and bundled pancreaticojejunostomy was performed in group B. The operation time, intraoperative blood loss, and pancreatic leakage of the two groups were assessed. The occurrence of pancreatic leakage after the operation in different patients was analyzed.

The differences in operative time and intraoperative bleeding between groups A and B were not significant (P > 0.05). In group A, the time of pancreatojejunostomy was 26.03 ± 4.40 min and pancreatic duct diameter was 3.90 ± 1.10 mm. These measurements were significantly higher than those in group B (P < 0.05). The differences in the occurrence of pancreatic leakage, abdominal infection, abdominal hemorrhage and gastric retention between group A and group B were not significant (P > 0.05). The rates of pancreatic leakage in patients with preoperative albumin < 30 g/L, preoperative jaundice time ≥ 8 wk, and pancreatic duct diameter < 3 mm, were 23.33%, 33.96%, and 19.01%, respectively. These were significantly higher than those in patients with preoperative albumin ≥ 30 g/L, preoperative jaundice time < 8 wk, and pancreatic duct diameter ≥ 3 cm (P < 0.05). Logistic regression analysis showed that preoperative albumin < 30 g/L, preoperative jaundice time ≥ 8 wk, and pancreatic duct diameter < 3 mm were risk factors for pancreatic leakage after PD (odds ratio = 2.038, 2.416 and 2.670, P < 0.05).

The pancreatointestinal anastomosis method during PD has no significant effect on the occurrence of pancreatic leakage. The main risk factors for pancreatic leakage include preoperative albumin, preoperative jaundice time, and pancreatic duct diameter.

• Pancreatoduodenectomy
• Pancreatojejunostomy
• Choice of operative methods
• Pancreatic leakage
• Multivariate analysis

• advanced colon cancer
• duodenal invasion
• ileal flap
• multivisceral resection
• pancreatoduodenectomy

En bloc right hemicolectomy with pancreatoduodenectomy (RHCPD) is the optimum treatment to achieve the adequate margin of resection (R0) for locally advanced right-sided colon cancer with duodenal invasion. Information regarding the indications and outcomes of this procedure is limited.

In this retrospective study, 2269 patients with right colon cancer underwent radical right colectomy between October 2010 and May 2019, in which 19 patients underwent RHCPD for LARCC were identified. The overall survival (OS), disease-free survival (DFS), operative mortality, postsurgical complications, gene mutational analysis, and prognostic factors were evaluated. Survival was estimated using Kaplan–Meir method.

Of these 19 patients who underwent LARCC, the OS was 88%, 66%, and 58% at 1, 3, and 5 years. The DFS was 72%, 56%, and 56% at 1, 3, and 5 years. The median operative time was 320 min (range: 222–410 min), and the median operative blood loss was 268 mL (range: 100–600 mL). The OS was significantly better among patients with well-differentiated tumor, N0 stage, and high microsatellite instability (MSI) and in patients who received adjuvant chemotherapy. The major postoperative complications occurred in 8 patients (42%), with pancreatic fistula (PF) being the most common. On the basis of the univariate analysis, poorly differentiated tumor, regional lymph node dissemination, MSI status, and no perioperative chemotherapy were the significant predictors of poor survival (P < 0.05).

This study suggests that RHCPD is feasible and can achieve complete tumor clearance with favorable outcome, particularly in patients with lymph node-negative status.

The online version contains supplementary material available at 10.1186/s12893-021-01286-0.

• En bloc resection
• Locally advanced right-sided colon cancer right hemicolectomy
• Pancreatoduodenectomy
• Survival

• Carcinosarcoma
• Pancreatoduodenectomy with hemicolectomy
• Region of pancreas head

• Acute abdomen
• Colectomy
• Locally advanced colon carcinoma
• Pancreaticoduodenectomy

• Abdomen, Acute/pathology
• Abdomen, Acute/surgery
• Adult
• Aged
• Colectomy
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Feasibility Studies
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Invasiveness/pathology
• Pancreaticoduodenectomy

• Colectomy
• Colonic neoplasms
• Extended pancreatectomy
• Hemicolectomy
• Multivisceral
• Pancreatic neoplasms
• Pancreaticoduodenectomy

• case report
• colorectal cancer
• en bloc resection
• multivisceral resection

• direct invasion to the duodenum and pancreas
• locally advanced right‐sided colon cancer
• pancreaticoduodenectomy
• right hemicolectomy

• Duodenal gastrointestinal stromal tumor (dGIST)
• surgery

Locally advancement of right colon cancer to the surrounding organs requiring surgical intervention is an extensive procedure associated with numerous risks. There are not many cases of which this phenomenon may occur. En bloc pancreaticoduodenectomy and resection of involved viscera should be considered for patients who can appropriately undergo this exhaustive surgery. Our objective is to report the experience we had with this patient who underwent an en bloc pancreaticoduodenectomy and right hemicolectomy and review literature. Our method was a retrospective review of a patient with colon cancer

Locally advanced right colon cancer may invade adjacent tissue and organs. Direct invasion of the duodenum and pancreas necessitates an en bloc resection. Previously, this challenging procedure was associated with high morbidity and mortality; however, today, this procedure can be done more safely in experienced centers. The aim of this study is to report our experience on en bloc right colectomy with pancreaticoduodenectomy for locally advanced right colon cancers. Between 2000 and 2012, 5 patients underwent en bloc multivisceral resection. No major morbidities or perioperative mortalities were observed. 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. One patient lived 70 months after multivisceral resection and underwent cytoreductive surgery and total pelvic exenteration during the follow-up period. In locally advanced right colon tumors, all adhesions should be considered as malign invasion and separation should not be done. The reasonable option for this patient is to perform en bloc pancreaticoduodenectomy and right colectomy. This procedure may result in long-term survival with acceptable morbidity and mortality rates. Multidisciplinary teamwork and multimodality treatment alternatives may improve the results.

Hereditary nonpolyposis colorectal cancer (HNPCC), or Lynch syndrome, accounts for 3 % of newly diagnosed cases of colorectal cancer. While a partial or subtotal colectomy is indicated for early stage disease, there is a paucity of data addressing locally advanced disease involving the foregut.

We report two patients with hereditary nonpolyposis colorectal cancer presenting with locally advanced colon cancer surgically managed by pancreaticoduodenectomy with en bloc partial colectomy and a review of the literature.

Locally advanced colorectal cancer in HNPCC is a rare clinical entity that requires special surgical consideration. Multidisciplinary treatment, including multi-visceral resection, offers the best long-term outcome.

• Adolescent
• Adult
• Aged
• Colectomy/adverse effects
• Colectomy/methods
• Duodenal Neoplasms/complications
• Duodenal Neoplasms/surgery
• Female
• Humans
• Male
• Middle Aged
• Morbidity/trends
• Pancreatic Neoplasms/complications
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/methods
• Postoperative Complications/epidemiology
• Propensity Score
• Quality Improvement
• Risk Assessment/methods
• Survival Rate/trends
• United States/epidemiology
• Young Adult