Discussion Of The Operation Approach In Colon Cancer With The Duodenum Invading

[objective]To investigate the surgical treatment and clinical effect for duodenal invasion of right colonic cancer.[Methods]We performed a retrospectively analysis of9patients who were treated from January2002to December2011in our hospital with infiltrated duodenum by colon cacinoma.including different clinic features and approach[Results]The9cases which invading duodenum are all right colon cancer.T4N0M03cases.T4N1M05cases.T4N2M01case.All cut edge are negative..According to duodenal infiltrated extents. they are divided into three types.In Type Ⅰ of4cases.2cases wereonly done a palliative resection to primary focus without did anything to duodenums.2cases were done a local resection to infiltrating focus besides resection of colon cancer.In Type Ⅱ of3cases vascularized terminal ileum flap repair were applied in additional to resection of colon cacer and infiltrating focus.In Type Ⅲ2cases,one case was done a local suture with pedicled gastric wall repair and duodenostomy besides resection of colon cacer and infiltrating focus.Right hemicolonectomy in combination with panceatoduodenectomy was in one case.After operation Type I4cases Type II3cases recoverd smoothly. In Type I:2cases which were not done with duodenums lived for9、1Omonths,the rest2cases have survived for2years.In type II:3cases lived for10、11、12months sepraterly,one of the case because of duodenal obstruction,jaundice was readmitted to hospital one month later,done gallblader-jejunumn、gaster-jejunum、Roux-en-Y anastomosis.survived for2months after the second operation.In type III:gastric obstrction occurred in one case who undergone gastric flap repair and cured by gastrojejunostomy2weeks later,survived for5months. In type III another case who developded pancreatic fistula10days later was undergone a second operation of"laparotomy,peritoneal lavage and drainage,jejunum stoma" died of respiratory failure22days after discharge automaticallv.[Conclusion]When colonic cancer infiltrate duodenum.a proper operation selection and surgical treatment is conductive to improve the prognosis.but expanded panceatoduodenectomy is still under controversial.