Clinical case of multivisceral en bloc resection for locally advanced cancer of the colon hepatic flexure

BACKGROUND: Currently, 15–20% of colorectal cancer cases are diagnosed at the locally advanced T4b stage. Treatment of this category of patients causes significant difficulties due to the degree of prevalence and the presence of a complicated course of the disease itself. AIM: Demonstration of a clinical case with an operation — multivisceral resection with pancreatoduodenal resection — for locally advanced cancer of the right half of the colon, as well as the oncological rationale for this operation. MATERIAL AND METHODS: This paper describes a case of treatment of a female patient with locally advanced adenocarcinoma of the colon hepatic angle, complicated by toxic-anemic syndrome and symptoms of partial intestinal obstruction. She underwent en bloc multivisceral resection with pancreatoduodenal resection. RESULTS: The patient was discharged on the 10th day after surgery in satisfactory condition, no complications were registered. Subsequently, adjuvant treatment was carried out: 5 courses of therapeutic polychemotherapy according to the XELOX regimen (capecitabine was received on an outpatient basis at a dose of 1500 mg 2 times a day, course 2 weeks). 12 months after surgery, progression of the disease in the form of metastases to the lungs was established, and 6 courses of bevacizumab therapy were administered. Currently the process has stabilized. CONCLUSION: A clinical case demonstrates the possibility of R0 resection for locally advanced cancer of the colon hepatic flexure with ingrowth into the liver, pancreas, duodenum and achieving good long-term results.