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      Duodenectomy with jejunal advancement and reimplantation of the ampulla of Vater for recurrent right colon cancer: A case report

      case-report

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          Highlights

          • A margin of resection for an advanced right colon cancer is the second portion of the duodenum.

          • Recurrence of right colon cancer may involve the anterior aspect of the duodenum.

          • Resection of the duodenum may occur without resection of the ampulla of Vater.

          • Reimplantation of the ampulla of Vater into the proximal jejunum was accomplished without adverse events.

          Abstract

          Background

          Local or regional recurrence of colon or rectal cancer frequently occurs if there is a positive margin of resection or spillage of cancer cells during the operation.

          Methods

          The clinical course of a patient with right colon cancer recurrent within the resection site and on the anterior aspect of the duodenum was reviewed.

          Results

          Resection of recurrent right colon cancer was accomplished by subtotal duodenectomy. Reconstruction was with jejunal advancement and reimplantation of the ampulla of Vater. No postoperative complications occurred and palliation was excellent.

          Conclusions

          Prevention of recurrent right colon cancer is an import consideration for primary resection. However, if this duodenum is involved by recurrence, techniques for resection exist.

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          Most cited references10

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          Update on the prevention of local recurrence and peritoneal metastases in patients with colorectal cancer.

          The prevention of a disease process has always been superior to the treatment of the same disease throughout the history of medicine and surgery. Local recurrence and peritoneal metastases occur in approximately 8% of colon cancer patients and 25% of rectal cancer patients and should be prevented. Strategies to prevent colon or rectal cancer local recurrence and peritoneal metastases include cytoreductive surgery and hyperthermic perioperative chemotherapy (HIPEC). These strategies can be used at the time of primary colon or rectal cancer resection if the HIPEC is available. At institutions where HIPEC is not available with the treatment of primary malignancy, a proactive second-look surgery is recommended. Several phase II studies strongly support the proactive approach. If peritoneal metastases were treated along with the primary colon resection, 5-year survival was seen and these results were superior to the results of treatment after peritoneal metastases had developed as recurrence. Also, prophylactic HIPEC improved survival with T3/T4 mucinous or signet ring colon cancers. A second-look has been shown to be effective in two published manuscripts. Unpublished data from MedStar Washington Cancer Institute also produced favorable date. Rectal cancer with peritoneal metastases may not be so effectively treated. There are both credits and debits of this proactive approach. Selection factors should be reviewed by the multidisciplinary team for individualized management of patients with or at high risk for peritoneal metastases.
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            Improving oncologic outcomes for colorectal cancer at high risk for local-regional recurrence with novel surgical techniques.

            Despite innovation in surgical technology, colorectal adenocarcinoma is a disease process with a risk of local and regional progression of disease. This article seeks to identify patients with primary disease who are at high risk for minimal residual disease from cancer spread after resection. These are the patients who will profit from novel perioperative surgical treatments that will improve the clearance and containment of cancer cells disseminated prior to or at the time of the adenocarcinoma resection. Clinical factors that identify these patients at high risk for local recurrence and peritoneal metastases are presented. Data regarding novel surgical techniques that include perioperative cancer chemotherapy to provide more optimal treatment are described. The perioperative timing of the revised surgical options is emphasized.
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              New prospects for the control of peritoneal surface dissemination of gastric cancer using perioperative intraperitoneal chemotherapy

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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                19 July 2019
                2019
                19 July 2019
                : 62
                : 1-4
                Affiliations
                [0005]Program in Peritoneal Surface Malignancies, MedStar Washington Hospital Center, 106 Irving St., NW, Suite 3900, Washington, DC 20010, USA
                Article
                S2210-2612(19)30404-3
                10.1016/j.ijscr.2019.07.022
                6700401
                31404898
                32d7e2fa-0fea-45a7-918f-3323956b4e8c
                © 2019 The Author

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 29 April 2019
                : 3 July 2019
                : 11 July 2019
                Categories
                Article

                local recurrence,reoperative,surgery,pancreaticoduodenectomy,whipple procedure

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