Total laparoscopic en bloc right hemicolectomy and pancreaticoduodenectomy with transvaginal specimen extraction for locally advanced right colon cancer: a case report

Abstract

For locally advanced right colon cancer (LARCC) invading duodenum, multivisceral resection is a curative surgical treatment, which is technically challenging when performed in a total laparoscopic approach. Herein, we report the first case of LARCC treated by total laparoscopic en bloc right hemicolectomy and pancreaticoduodenectomy with transvaginal specimen extraction. The patient was a 37-year-old female suffering from upper abdominal pain who was diagnosed with LARCC invading the duodenum by preoperative examination. The en bloc resection and digestive tract reconstruction were completed laparoscopically without an assisted abdominal incision. Then the specimen was extracted transvaginally through a 6 cm transverse incision made in the posterior vaginal fornix and the vaginal incision was closed by a continuous suture intracorporeally. The operative time was 470 min and intraoperative blood loss was 130 mL. The postoperative pathological examination showed T4bN0M0 adenocarcinoma of the hepatic flexure of colon with infiltration of duodenal serosa, and all the margins were negative. The patient recovered uneventfully with minimal postoperative pain and was discharged from hospital on postoperative day 7. After 3 years of follow-up, the patient was alive with no recurrence. To the best of our knowledge, this is the most extensive multivisceral resection with natural orifice specimen extraction (NOSE) ever reported.We believe that NOSE surgery, with advantages of minimal invasiveness and enhanced recovery, is a feasible and promising option for LARCC.

The long-term outcomes and prognostic factors about locally advanced right colon cancer: a retrospective cohort study

“…For resectable locally advanced right hemicolon cancer, there are still many issues that deserve to be investigated, not only in terms of patient survival, but also advances in surgical techniques. Laparoscopic en bloc resection and transvaginal specimen extraction have been reported in relevant cases ( 29 ), and the advancement of surgical techniques may lead to fewer complications and shorter hospitalization. Laparoscopic complete mesocolic excision (CME) in right-sided colonic cancer resections has a higher number of lymph node dissection than open surgery and has shorter hospitalization days ( 30 ), exploring advances in surgical technique and performing laparoscopic resection of locally advanced right hemicolon cancer when R0 resection is possible is a direction for our subsequent research.…”

Robotic Enbloc Pancreaticoduodenectomy with Right Hemicolectomy and Non-Anatomical Segment VI Liver Resection for Malignant Colo Duodenal Fistula

“…Minimally invasive approach useful in early postop recovery, less postoperative pain and early return to adjuvant chemotherapy. There are few reports of laparoscopic enbloc pancreatoduodenectomy with right hemicolectomy [3,[6][7][8][9] But, there is no report available in English literature about robotic combined Whipple with right hemicolectomy for malignant colo-duodenal fistula. This is first case of enbloc pancreaticoduodenectomy with right hemicolectomy done by robotic approach using DaVinci Xi approach.…”

Transvaginal Natural Orifice Specimen Extraction Following Laparoscopic Combined D3 Right Hemicolectomy and Liver Resection

“…The first is a case of en bloc right colectomy with pancreaticoduodenectomy with transvaginal specimen extraction. 9 The second is a patient who underwent anterior resection and liver metastasectomy with transanal specimen extraction. 10…”

“…The first is a case of en bloc right colectomy with pancreaticoduodenectomy with transvaginal specimen extraction. 9 The second is a patient who underwent anterior resection and liver metastasectomy with transanal specimen extraction. 10 In the present video, we demonstrate the transvaginal specimen retrieval method after D3 right hemicolectomy for caecal adenocarcinoma with liver segment VII metastasectomy.…”