Int J Colorectal Dis (2006) 21: 265–268 DOI 10.1007/s00384-005-0756-z ORIGINAL ARTICLE Sorabh Kapoor Biswabasu Das Sujoy Pal Peush Sahni Tushar K. Chattopadhyay Accepted: 9 February 2005 Published online: 7 June 2005 # Springer-Verlag 2005 En bloc resection of right-sided colonic adenocarcinoma with adjacent organ invasion Abstract Background: Right-sided colon cancers that invade the adjacent organs are often missed on preopera- tive imaging. These patients are often considered unresectable at laparotomy as the surgeon is not prepared for en bloc resections. A few centers have reported extended survival after en bloc resection in such tumors. We therefore decided to evaluate the out- come of our patients after en bloc right hemicolectomy. Patients and methods: The records of all patients who underwent en bloc resection of adjacent organs for right colon can- cers were analyzed. Results: Be- tween 1992 and 2004, 11 patients had an en bloc right hemicolectomy for right-sided colon cancer. There were ten males and one female with a mean age of 44 years (35–80 years). All patients had anaemia at presentation and most had weight loss and a fixed palpable lump. Preoperative CT scan was able to detect adjacent organ infiltration in nine patients. Six pa- tients had an en bloc pancreaticoduo- denectomy, three patients had en bloc local excision of duodenal wall, one patient had en bloc resection of segments 5 and 6 of the liver and one patient had en bloc distal gastrectomy. There was one operative mortality after an en bloc pancreaticoduode- nectomy. The median disease-free survival was 54 months. Conclusion: Right-sided colon can- cers that invade adjacent organs in the absence of distant spread may be a subset of tumors that behave in a locally aggressive manner without causing hematogenous spread. En bloc resection of these tumors is possible, in select centers, with low mortality and morbidity and extended survival. Keywords Hemicolectomy . Colon cancer . Pancreaticoduodenectomy S. Kapoor (*) . B. Das . S. Pal . P. Sahni . T. K. Chattopadhyay Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Room No 1007, 1st floor, PC block, Ansari Nagar, New Delhi, 110029, India e-mail: sorabhkapoor@hotmail.com Tel.: +91-11-26593461 Fax: +91-11-26588641 Introduction Colorectal cancers infiltrate adjacent organs in 5.5–16.7% of cases [1]. Although extracolonic spread is common in rectosigmoid tumors it is seen less often in right-sided colon cancers [2–6]. Right-sided colon cancers which invade the adjacent pancreas and duodenum pose a sur- gical challenge, because complete removal of these tumors involves resection of multiple infiltrated adjacent organs. Such locally infiltrative tumors are often considered un- resectable. In addition, adjacent organ infiltration is often identified for the first time at surgery when the patient and surgeon might not be fully prepared for a surgical resection of such magnitude. Adjacent organ resection for right-sided colon cancers has been done previously; the first description of a simultaneous duodenal resection with a right hemicolectomy was by Grey Turner in 1929 [7]. Van Prohaska et al., in 1956, described the first en bloc pancreaticoduodenectomy for right colon cancer [8]. In the past decade, more centers are doing pancreaticoduodenectomy for periampullary and pancreatic cancer with a low mortality [9]. However, only few case series, involving small number of patients, have described adjacent organ resection for right colon cancers [2, 4, 10, 11]. Most of these series have reported extended survival after these complex procedures with a low operative mortality and morbidity [12–15]. Despite the large number of colon re- sections performed all over the world, little information is