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.