Successful Multivisceral Resection for advanced Colonic Cancer in a neglected Cachectic patient

in Max Super Speciality Hospital, Vaishali

Feb 02 , 2023

A 60-year-old patient was diagnosed with hepatic flexure colonic adenocarcinoma with duodenal (1 st & 2 nd part) infiltration in December 2021. Initially, he received neoadjuvant chemotherapy, to which he responded partially. He then defaulted from treatment. Over time, his condition worsened with recurrent vomiting, poor oral intake and significant weight loss.

He consulted with the doctors at Max Super Speciality Hospital, Vaishali, in a cachectic state after an evaluation with PET - CT, which showed a significant increase in the size of the tumour with both partial colonic and high grade duodenal obstruction without any distant metastases and was offered palliative treatment outside. The case was reviewed, and it was decided to offer curative intent treatment after due deliberation in Tumour Board, with initial nutritional build-up with nasojejunal tube feeding.

During the nutritional build-up, he received six Page No 08 cycles of chemotherapy. Reassessment showed a partial response to chemotherapy. En Bloc Whipple with radical (D3) right colectomy was done on at Max Hospital, Vaishali. The post-operative period was uneventful. The patient was discharged within a week. Biopsy revealed adenocarcinoma ypT4 N2a (full thickness duodenal involvement, 5/45 lymph nodes positive).

All margins were clear. The patient has been doing well since then and has been planned for adjuvant chemotherapy. This case highlights that excellent outcomes can be achieved, even in patients with advanced colonic cancer, when managed by a dedicated team willing to put a lot of extra effort into an individual patient.

Good treatment planning followed by a perfect execution by involved teams ensures a good outcome when managing such complex patients and surgeries.

Multivisceral resections are being routinely performed by our team, whenever indicated, in patients with abdominal cancers.