EP943 - En Bloc Pancreaticoduodenectomy and Right Colectomy in a Community Hospital at the Southern border

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Purpose/Background: Pancreaticoduodenectomy is one of the most challenging abdominal surgical procedures and is associated with increased rates of postoperative complications. Even at very high-volume tertiary centers for pancreatic resections, the morbidity rates after a pancreaticoduodenectomy are relatively high. Therefore, pancreaticoduodenectomy and colectomies are surgical procedures with a high risk of morbidity and mortality.

Methods/Interventions: Our patient was a 56-year-old Hispanic male with past medical history of hypertension who presented with several months of right upper quadrant pain, bloating, general body weakness, diminished appetite and weight loss. Colonoscopy showed a sessile obstructive mass in the hepatic flexure consistent with colonic adenocarcinoma that was involving the entire lumen and unable to pass the obstruction with the scope. CT scan (Figure 1) shows that the mass measured 12cm mass extending from hepatic flexure to duodenum, involving the gastroduodenal artery.
The patient presented to our hospital, a community, physician-owned, 500+ bed level 1 Trauma Center. We are located 20 miles from the Mexico-USA boarder, providing care to the Rio Grande Valley and the most southern, mostly Hispanic population in the country.

Results/Outcomes: In a combo case involving a hepatobiliary surgeon and a colorectal surgeon, the patient underwent en bloc resection of transverse colon mass with resection of head of pancreas, duodenum, and distal stomach (non-pylorus-preserving). (Figure 2) Decision was made to proceed with a diverting loop ileostomy. The histopathological diagnosis was pT4b pN0 (Stage IIC), with over 50 lymph nodes obtained. Patient was discharged after 12 days after an uncomplicated post operative course. His ileostomy was reversed 2 months later with no complications. Patient is now scheduled to start treatment with FOLFOX, Oxaliplatin, 5 FU.

Conclusion/Discussion: We suggest that pancreatoduodenectomy associated with right colectomy can be safely performed on colon cancer patients that present at community hospitals when the adequate resource is available. This is especially important in remote areas of the country, which can serve as a tool to improve access to health care. Although the additional of ileostomy may bring disadvantages, most notably rehydration, we opted to use it to prevent any possible devastating ileocolonic anastomosis leaks complication. Carefully selecting patients is essential to mitigate the potentially severe complications of the two combined surgical procedures and maximize the oncological benefits.