Radical surgery of colon cancers directly invading the duodenum, pancreas and liver.

BACKGROUND/AIMS: Adjacent organ invasion is observed in 5-12% of the colorectal cancers and is rarely faced with invasion of the duodenum, pancreas or liver. METHODOLOGY: We reviewed 4 patients with invasion of the duodenum, pancreas or liver or more than one at the same time, to emphasize the importance of aggressive radical procedures. RESULTS: Three patients underwent en bloc pancreaticoduodenectomy with right hemicolectomy, and one patient underwent en bloc pancreaticoduodenectomy with right hemicolectomy and 5th and 6th hepatic segments resection. Perioperative need for blood transfusion was 3-5 units. There was no postoperative morbidity and mortality, except for the patient who had a bile leakage which got well with medical treatment. Although malignant invasion was proved by pathologic evaluation, only one patient had lymph node involvement. While one patient was lost at the 8th postoperative month, 3 patients are living disease free within a range of 14-41 months. CONCLUSIONS: The chances of longer survival can be given to the patient by en bloc radical resections of locally advanced right colon tumors accompanied by invasion of duodenum, pancreas and liver, with low morbidity and mortality rates.

Pneumoperitoneum-assisted harvesting of split-thickness skin grafts from the abdomen.

Harvesting split-thickness skin grafts from the abdomen is difficult when using a conventional hand dermatome. In this study, pneumoperitoneum was created in 10 patients before skin grafts were taken. No complications arose from the insufflation, and the conventional dermatome was then easy to use. Pneumoperitoneum provides more abdominal surface area, allowing the surgeon to harvest a greater number of larger, more uniform grafts during a single procedure, even when working near an anatomical protuberance.