PDF(Pubmed)
Abstract：
UNASSIGNED: Irresectable colon cancer presents a complex clinical challenge. Neoadjuvant immunotherapy has shown potential in improving resectability. Additionally, advancements in surgical techniques, including complete mesocolic excision (CME) with central vascular ligation (CVL), have contributed to better outcomes for right-sided colon cancer. This case report aims to demonstrate the successful laparoscopic resection of initial appearing irresectable colon cancer with suspected duodenal involvement.
METHODS: A 70-year-old female presented with an irresectable mismatch repair deficient (dMMR) adenocarcinoma of the ascending colon with suspected duodenal ingrowth. Neoadjuvant treatment with pembrolizumab and ataluren resulted in a significant response, allowing for surgical resection. A laparoscopic right hemicolectomy with CME, including CVL, intracorporeal anastomosis and extraction through a Pfannenstiel incision, was performed. Additionally, the serosal layer of the duodenum was shaved after observing the absence of intraluminal invasion. Postoperatively, transient gastroparesis occurred, but overall outcomes were favourable.
UNASSIGNED: This case emphasizes the potential of immunotherapy in improving resectability for irresectable dMMR colon cancer with suspected involvement of surrounding organs. The combination of neoadjuvant therapy and advanced surgical techniques, such as CME with CVL, shows promise in achieving favourable clinical outcomes. However, further studies are needed to validate the effectiveness and safety of this combined approach in a larger cohort of patients.
CONCLUSIONS: The successful laparoscopic resection of initially irresectable dMMR colon cancer with duodenal involvement, following neoadjuvant immunotherapy, demonstrated promising outcomes. This case advocates for further exploration of neoadjuvant treatments\' efficacy, coupled with advanced surgical techniques, in managing locally advanced right-sided colon cancer.
METHODS: A 70-year-old female presented with an irresectable mismatch repair deficient (dMMR) adenocarcinoma of the ascending colon with suspected duodenal ingrowth. Neoadjuvant treatment with pembrolizumab and ataluren resulted in a significant response, allowing for surgical resection. A laparoscopic right hemicolectomy with CME, including CVL, intracorporeal anastomosis and extraction through a Pfannenstiel incision, was performed. Additionally, the serosal layer of the duodenum was shaved after observing the absence of intraluminal invasion. Postoperatively, transient gastroparesis occurred, but overall outcomes were favourable.
UNASSIGNED: This case emphasizes the potential of immunotherapy in improving resectability for irresectable dMMR colon cancer with suspected involvement of surrounding organs. The combination of neoadjuvant therapy and advanced surgical techniques, such as CME with CVL, shows promise in achieving favourable clinical outcomes. However, further studies are needed to validate the effectiveness and safety of this combined approach in a larger cohort of patients.
CONCLUSIONS: The successful laparoscopic resection of initially irresectable dMMR colon cancer with duodenal involvement, following neoadjuvant immunotherapy, demonstrated promising outcomes. This case advocates for further exploration of neoadjuvant treatments\' efficacy, coupled with advanced surgical techniques, in managing locally advanced right-sided colon cancer.
摘要：
■不可切除的结肠癌提出了复杂的临床挑战。新辅助免疫疗法已显示出改善可切除性的潜力。此外,手术技术的进步，包括完整的结肠系膜切除术（CME）和中央血管结扎（CVL），有助于改善右侧结肠癌的预后。此病例报告旨在证明腹腔镜成功切除了最初出现的不可切除的结肠癌，怀疑十二指肠受累。
方法：一名70岁女性患者出现不可切除的升结肠错配修复缺陷（dMMR）腺癌，怀疑十二指肠向内生长。pembrolizumab和ataluren的新辅助治疗产生了显著的反应，允许手术切除.CME腹腔镜右半结肠切除术，包括CVL,通过Pfannenstiel切口进行体内吻合和拔除，已执行。此外,在观察到没有腔内侵入后，十二指肠的浆膜层被剃光。术后,发生一过性胃轻瘫,但总体结果是有利的。
■该病例强调了免疫治疗在改善不可切除的dMMR结肠癌并怀疑累及周围器官的可切除性方面的潜力。新辅助治疗和先进手术技术的结合，例如带有CVL的CME，在实现有利的临床结果方面显示出希望。然而,需要进一步的研究在更大的患者队列中验证这种联合治疗方法的有效性和安全性.
结论：成功的腹腔镜切除了十二指肠受累的最初不可切除的dMMR结肠癌，在新辅助免疫疗法之后，展示了有希望的结果。本案主张进一步探索新辅助治疗的疗效，加上先进的手术技术，治疗局部晚期右侧结肠癌。
方法：一名70岁女性患者出现不可切除的升结肠错配修复缺陷（dMMR）腺癌，怀疑十二指肠向内生长。pembrolizumab和ataluren的新辅助治疗产生了显著的反应，允许手术切除.CME腹腔镜右半结肠切除术，包括CVL,通过Pfannenstiel切口进行体内吻合和拔除，已执行。此外,在观察到没有腔内侵入后，十二指肠的浆膜层被剃光。术后,发生一过性胃轻瘫,但总体结果是有利的。
■该病例强调了免疫治疗在改善不可切除的dMMR结肠癌并怀疑累及周围器官的可切除性方面的潜力。新辅助治疗和先进手术技术的结合，例如带有CVL的CME，在实现有利的临床结果方面显示出希望。然而,需要进一步的研究在更大的患者队列中验证这种联合治疗方法的有效性和安全性.
结论：成功的腹腔镜切除了十二指肠受累的最初不可切除的dMMR结肠癌，在新辅助免疫疗法之后，展示了有希望的结果。本案主张进一步探索新辅助治疗的疗效，加上先进的手术技术，治疗局部晚期右侧结肠癌。
