Oncological outcomes of multivisceral operations with pancreatoduodenalectomy for colorectal cancer

AIM: to estimate early and late outcomes of multivisceral surgeries (MVS) with pancreaticoduodenalectomy (PD) for colorectal cancer.
PATIENTS AND METHODS: the main group included 42 patients who underwent MVS with PD for colorectal cancer from January 2011 to April 2024. The control group included 46 patients with colorectal cancer who underwent colorectal resection with resection of the duodenum and/or head of the pancreas, i.e. MVS without PD.
RESULTS: controls were more likely to have ECOG status 2-3 (44/46 (95.7%) vs. 33/42 (78.6%), p = 0.022), were more likely to have tumor stenosis of the colon/duodenum (31/46 (67.4%) vs. 16/42 (38.1%), p = 0.006), were less likely to have ischemic heart disease (6/46 (13.0%) vs. 14/42 (33.3%), p = 0.023), and were less likely to have pancreatic invasion (5/46 (10.9%) vs. 20/42 (47.6%), p = 0.001). Control patients (MVS without PD) received adjuvant chemotherapy (ACT) significantly more often (34/46 (73.9%) vs. 21/42 (50.0%), p = 0.021). The incidence of postoperative complications by Clavien-Dindo grade 3 and higher and mortality in both groups were comparable (13/42 (31%) vs. 11/46 (23.9%), p = 0.2) and (3/42 (7.1%) vs. 3/46 (6.5%), p = 1,0), respectively. The risk of locoregional recurrence in the control group was significantly higher (18/43 (41.9%) vs. 4/33 (12.1%), p = 0.005). Locoregional recurrence was an independent negative factor of prognosis in the control group (HR 3.96; 95% CI (1.66–9.44), p = 0.002). Overall five-year survival in the main group (MVS with PD) was 42.1%, (95% CI (17.2–65.4), and in the control one (MVS without PD) — 26.4% (95% CI (11.8–43.6). The median overall survival in the main group was 44 months (95% CI: 26 — ∞), in the control one — 13 (95% CI: 10–31). The differences in overall survival rates were significant (p = 0.005). The risk of mortality in the late period in the control group was significantly higher (HR 2.49; 95% CI (1.27–4.91), p = 0.008). In univariate analysis, superior mesenteric vein invasion had a significant effect on overall survival (HR 21.84; 95% CI (1.52–313.78), p = 0.02.) The only independent factor of negative prognosis is metastases in 4 or more regional lymph nodes (N2 of the primary tumor). Multivariate analysis revealed that independent negative factors for overall survival rates were locoregional recurrence (HR 4.65; 95% CI (2.1–10.44), p < 0.001), invasion of the superior mesenteric vein (HR 41.77; 95% CI 4.25–409.73, p = 0.001), and positive factors were the fact of performing MVS with PD (HR 0.29; 95% CI (0.12–0.7), p = 0.005) and adjuvant chemotherapy (HR 0.34; 95% CI 0.14–0.8, p = 0.013).
CONCLUSION: multivisceral resection with pancreaticoduodenectomy for local advanced colorectal cancer with duodenal and / or pancreatic head invasion is the operation of choice in the presence of appropriate conditions.

1. Sattari SA, Sattari AR, Makary MA, et al. Laparoscopic Versus Open Pancreatoduodenectomy in Patients With Periampullary Tumors: A Systematic Review and Meta-analysis. Ann Surg. 2023;277(5):742– 755. doi: 10.1097/SLA.0000000000005785

2. Kokkinakis S, Kritsotakis EI, Maliotis N. et al. Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int. 2022;21(6):527–537. doi: 10.1016/j.hbpd.2022.04.006

3. Shimizu A, Motoyama H, Kubota K, et al. Safety and Oncological Benefit of Hepatopancreatoduodenectomy for Advanced Extrahepatic Cholangiocarcinoma with Horizontal Tumor Spread: Shinshu University Experience. Ann Surg Oncol. 2021;28(4):2012–2025. doi: 10.1245/s10434-020-09209-8

4. Ri H, Kang H, Xu Z, et al. Surgical treatment of locally advanced right colon cancer invading neighboring organs. Front. Med. 2023;9:1044163. doi: 10.3389/fmed.2022.1044163

5. Jin P, Liu H, Ma FH, et al. Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion. World J Clin Cases. 2021;9(29):8718–8728. doi: 10.12998/wjcc.v9.i29.8718

6. Cojocari N, Crihana GV, Bacalbasa N, et al. Right-sided colon cancer with invasion of the duodenum or pancreas: A glimpse into our experience. Exp Ther Med. 2021;22(6):1378. doi: 10.3892/etm.2021.10813

7. Zhu R, Grisotti G, Salem RR, et al. Pancreaticoduodenectomy for locally advanced colon cancer in hereditary nonpolyposis colorectal cancer. World J Surg Oncol. 2016;14(1):12. doi: 10.1186/s12957-015-0755-7

8. Meng L, Huang Z, Liu J, et al. En bloc resection of a T4B stage cancer of the hepatic flexure of the colon invading the liver, gall bladder, and pancreas/duodenum: A case report. Clin Case Rep. 2020;8(12):3524–3528. doi: 10.1002/ccr3.3455

9. Khalili M, Daniels L, Gleeson EM, et al. Pancreaticoduodenectomy outcomes for locally advanced right colon cancers: A systematic review. Surgery. 2019;166(2):223–229. doi: 10.1016/j.surg.2019.04.020

10. Egorov V.I., Akhmetzyanov F.S., Kaulgud H.A., et al. Clinical case of multivisceralen bloc resection for locally advanced cancer of the colon hepatic flexure. Kazan medical journal. 2024;105(4):669–676. (In Russ.). doi: 10.17816/KMJ628774

11. Patyutko Yu.I., Kudashkin N.E., Kotelnikov A.G. Surgical treatment of locally advanced cancer of the right half of the colon. Onkologičeskaâ koloproktologiâ. 2014;(2):28–32. (In Russ.).

12. Kasatkin V.F., Kit O.I., Kolesnikov E.N., et al. Pancreatoduodenal resection for gastric cancer and colon cancer. Novocherkassk: “Lik”, 2014; 268 p. (In Russ.).

13. Cirocchi R, Partelli S, Castellani E, et al. Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/ or only duodenum. Surg Oncol. 2014;23(2):92–8. doi: 10.1016/j.suronc.2014.03.003

14. Shchaeva S.Т., Efron A.G., Magidov L.A., et al. Overall survival in elderly patients with acute complications of colorectal cancer. Koloproktologia. 2021;20(3):62–70. (In Russ.). doi: 10.33878/2073-7556-2021-20-3-62-70

15. Body A, Prenen H, Latham S, et al. The Role of Neoadjuvant Chemotherapy in Locally Advanced Colon Cancer. Cancer Manag Res. 2021;13:2567–2579. doi: 10.2147/CMAR.S262870

16. Kaidarova D, Smagulova K, Yesentaeva S, et al. Advanced colorectal cancer and risk factors for survival. Annals of Oncology. 2018;29:v75-v76. doi: 10.1093/annonc/mdy151.267

17. Lee CH, Cheng SC, Tung HY, et al. The Risk Factors Affecting Survival in Colorectal Cancer in Taiwan. Iran J Public Health. 2018 Apr;47(4):519–530.