Surgical procedures
The tumor was located in the hepatic flexure of the colon, with adhesion
to the right side of the descending part of the duodenum, and had
invaded the right lobe of the liver. We could not resect the tumor using
a common procedure. We dissected the right side of the hepatoduodenal
ligament, and opened the hepatogastric ligament beside hepatoduodenal
ligament, from left to right by using a thumb, to determine if the tumor
had invaded the right side of the portal vein. We then we opened the
ascending colon paracolic sulci, dissected the portal vein beside the
pancreas/duodenum and Toldt’s fascia, and confirmed that the tumor had
not invaded post cava.
We then dissected the right hemicolon Toldt’s fascia, beside the
ileocolonic vessels and in front of the superior mesenteric artery, and
confirmed that the tumor had not invaded the superior mesenteric vein.
We performed a D3 expanded right hemicolectomy + pancreaticoduodenectomy
+ sectional VI and VII hepatic segmentectomy en-bloc resection on this
patient (Figure 4). During the procedure, we paid attention to whether
the tumor had invaded the superior mesenteric vein and post cava.
Postoperative amylase levels were continuously monitored in the
abdominal drainage tube and t-tube drainage fluid for 5 days.
The information regarding the abdominal drainage tube is listed in table
1. Postoperative pathology: 1. (right semicolon) medium-poorly
differentiated tubular adenocarcinoma, mass infiltration type, size 6 ×
5 × 4.5 cm, carcinoma tissue had infiltrated the whole layer of the
intestinal wall and had broken through the serosal layer; carcinoma
tissue had invaded the liver, gallbladder, pancreas, and duodenum;
Microscopy examination revealed a partial necrosis and focal
calcification, as well as a vascular carcinoma thrombus and nerve
invasion. Chronic inflammation of the colonic mucosa was noted. The
samples of the stomach, ileum, and appendix showed chronic inflammation
of the mucosa, but no cancer. 2. The pancreatic resection margin was
positive. The liver, stomach, duodenum, ileum, and colon were all
negative. 3. Four of four lymph nodes (12 groups) and 13 of 22 lymph
nodes (mesenteric lymph nodes) were examined for metastatic carcinoma
with a maximum diameter of 1.3cm; an additional 2 nodules of carcinoma
were noted.
The recovery of the patient was uneventful after 3 months of follow-up.