Pancreas sparing duodenal resection in colorectal adenocarcinoma with local invasion to the duodenum: a case report and literature review

Abstract

Background . Pancreas sparing duodenal resection (PSDR) is commonly described in patients with familial duodenal adenomatous polyposis, duodenal gastrointestinal stromal tumours, duodenal trauma, or other primary duodenal lesions where the pancreas is not involved. PSDR in patients with metastatic involvement of the duodenum is rarely described. After reviewing the relevant literature, less than five PSDR for duodenal metastases reports were retrieved. Our patient was treated with PSDR for a local recurrence after a right hemicolectomy performed for right colon adenocarcinoma a year before. Aim . To investigate if PSDR is feasible in this patient with recurrence of a locally advanced right colon adenocarcinoma invading the duodenum Case Summary . A 74-year-old female patient presented with right iliac fossa pain and weight loss one year post-resection of the primary ascending colon cancer. A surveillance computed tomography (CT) scan of the thorax, abdomen and pelvis showed a mass in the third segment of the duodenum. The decision to carry out a PSDR was made. Results . The proximal and distal margins of the resected bowel were uninvolved by the invasive carcinoma, and metastasis in five out of 12 regional lymph nodes was found. The postoperative course was complicated by a grade B postoperative pancreatic fistula (POPF) but recovered well post drainage. Conclusions . PSDR can be utilized in the management of duodenal metastases. Relevance for patients . PSDR can be performed in patients with duodenal metastases, offering a lower morbidity rate as compared to conventional pancreaticoduodenectomy.