J.Jpn. Surg. Soc.. 119(5): 470-474, 2018

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Feature topic

TREATMENT STRATEGY FOR ASCENDING COLON CANCER WITH INVASION OF THE DUODENUM

Because the ascending and transverse colons are located near the second and third portions of the duodenum, primary tumors or metastatic lymph nodes often involve the duodenum. Surgical procedures to be selected for such tumors should be determined depending on the anatomical extent of spread. When removal of the pancreas head and/or lymph nodes around the duodenum is necessary, pancreatoduodenectomy may be an option. Conversely, when tumors do not involve the pancreas, partial resection of the duodenum can be selected. It should be noted that failure of the repair of the duodenum occasionally causes critical clinical conditions; external drainage of the bile duct and pancreatic duct with double-tract-type reconstruction is recommended for cases with large defects in the duodenal wall. Neoadjuvant chemotherapy may be an attractive option for massive ascending colon tumors involving other organs because subsequent tumor regression could be associated with an increased probability of tumor resectability and avoidance of extended surgery. Considering clinical symptoms, such as diarrhea and fecal vomiting, in patients with cancerous fistula between the colon and duodenum and relatively favorable prognostic outcome in T4b colon cancer patients, curatively intended surgical treatment is strongly recommended for patients with colon cancer showing invasion of the duodenum.

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