ABSTRACT
PURPOSE: We undertook this study to analyze clinical features and surgical outcome of en bloc resections of the right side colon cancer directly invading duodenum and/or pancreatic head. MATERIALS AND METHODS: The records of all patients who underwent en bloc resection of duodenum and/or pancreas for right colon cancers were analyzed retrospectively. From September 1994 to September 2006, 1,016 patients underwent curative right hemicolectomy. Nine patients (0.9%) had en bloc resection of a right side colon cancer with duodenum or pancreatic head invasion. RESULTS: The median operative time was 320 minutes (range, 200-420) and the median blood loss was 700 mL (range, 100-2,000). The mean size of tumor was 6.6 cm (range, 3.2-10.7). The mean preoperative carcinoembryonic antigen (CEA) was 10.6 ng/mL (range, 0.2-50.8). There was no 30 day perioperative mortality. The median disease-free survival was 23.5 months [95% confidence interval (CI) 5.2-41.8] and the median overall survival was 28.1 months (95% CI 9.7-46.5). CONCLUSIONS: In patients with locally advanced right side colon cancer that directly invades the duodenum or pancreas can be safely resected with curative potential with minimum morbidity and mortality. Long term disease free survival can occur in a significant number of patients undergoing curative en bloc resection in this particular subset of patients.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Camptothecin/analogs & derivatives , Chemotherapy, Adjuvant , Colonic Neoplasms/complications , Disease-Free Survival , Duodenal Neoplasms/drug therapy , Duodenum/drug effects , Fluorouracil/pharmacology , Leucovorin/pharmacology , Organoplatinum Compounds/pharmacology , Pancreas/drug effects , Pancreatic Neoplasms/drug therapy , Retrospective Studies , Treatment OutcomeABSTRACT
Gastrointestinal stromal tumors (GIST) are lesions whose diagnosis and treatment have varied in the last decade. We report a 76 year-old male with a history of eight episodes of upper gastrointestinal bleeding. A duodenography showed an elevated lesion in the third portion of the duodenum with a central ulceration. It was initially managed with tumorectomy and primary closure of the duodenum. The pathological study of the surgical specimen revealed a low grade gastrointestinal stromal tumor. Three years later, the tumor recurred and pancreatoduodenectomy was performed. Due to the high risk of malignant potential, tumor size, number of mitoses and the presence of necrosis, imatinib mesylate was started. The patient had a satisfactory evolution, without evidences of recurrence after 15 months of follow up.
Subject(s)
Aged , Humans , Male , Duodenal Neoplasms , Gastrointestinal Stromal Tumors , Antineoplastic Agents/therapeutic use , Duodenal Neoplasms/drug therapy , Duodenal Neoplasms/pathology , Duodenal Neoplasms/surgery , Duodenal Ulcer/drug therapy , Duodenal Ulcer , Duodenal Ulcer/surgery , Gastrointestinal Hemorrhage/drug therapy , Gastrointestinal Hemorrhage , Gastrointestinal Hemorrhage/surgery , Gastrointestinal Stromal Tumors/drug therapy , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/surgery , Pancreaticoduodenectomy , Piperazines/therapeutic use , Proto-Oncogene Proteins c-kit , Pyrimidines/therapeutic use , RecurrenceABSTRACT
El cáncer primitivo del duodeno (CPD) es raro, y en nuestro Hospital representa el 0,008% de las biopsias. En el período 1945-90, descartando los tumores de la ampolla de Vater, hallamos catorce casos: ocho adenocarcinomas (ADC), cinco linfomas y un histiocitoma maligno. Los ADC generalmente son periampulares; los otros dos tumores son infraampulares. La sintomatología más frecuente fue dolor, obstrucción duodenal y compromiso del estado general, de comienzo insidioso. El dolor abdominal predominó en los pacientes con ADC y la diarrea, en los enfermos con linfomas. El diagnóstico, por lo general es tardío, cuando el tumor está avanzado. El diagnóstico etiológico se hizo principalmente por biopsia endoscópica (12 casos), y quirúrgica, sólo en 2 casos. La radiología con medio de contraste y el TAC abdominal son técnicas complementarias y permiten conocer la extensión de la lesión. El tratamiento de los adenocarcinomas es quirúrgico: pancreatoduodenectomía en las formas localizadas; cirugía derivativa paliativa en las formas avanzadas, que son las más frecuentes. En los linfomas, la quimioterapia es el tratamiento de elección, además de cirugía resectiva para los casos localizados. En el seguimiento hallamos sólo un paciente vivo, que corresponde a una enferma con linfoma no Hodgkin, sometida a cirugía resectiva y quimioterapia, 52 meses antes. La mayor sobrevida alcanzada en nuestra serie, fue de 13 años, y corresponde a una paciente con ADC sometida a pancreatoduodenectomía radical. La sobrevida promedio de los pacientes con linfomas que han fallecido, es superior a la de aquellos con adenocarcinomas (39 meses vs. 27 meses)