Successful complex surgery for advanced colon cancer

27 May, 2023

Excellent outcomes can be achieved even in patients with advanced colorectal cancer when managed by a dedicated team willing to put a lot of extra effort in an individual patient. The following case highlights how, firm resolve of the patients and their families and good treatment planning followed by a perfect execution by the treating teamis needed when managing such complex patients and surgeries.

A 60 years patient resident of Uttarakhand was diagnosed with advanced colon cancer (https://www.drvivekmangla.com/video.html) (large intestine) cancer with involvement of 1st and 2nd part of duodenum (proximal most part of small intestine) in December 2021. Hehad been treated outside with chemotherapy to which he responded partially but then he stopped treatment. Over time, his condition worsened with recurrent vomiting, poor oral intake and significant weight loss. In July ’22, he came to us in a cachectic state, with a large mass involving the colon and duodenum (the proximal most part of small intestine) with both partial colonic and high grade duodenal obstruction without any distant metastases and was offered palliative (non curative) treatment outside. The case was reviewed in the GI Tumour Board and planned for curative intent treatment with initial nutritional build up with tube feeding. During nutritional build up, he was also given chemotherapy to halt disease progression. Reassessment showed that the colon cancer had a partial response to chemotherapy. At this point, a major surgery lasting about 10 hours, entailing removal of the organs involved by the tumour (pancreatic head, duodenum, gall bladder, bile duct, right side of colon, a part of stomach, a part of proximal and distal small intestine) technically called an En Bloc Whipple with radical (D3) right colectomy was done on by us. Patient had an uneventful recovery and was discharged after 7 days. The patient has recovered, eating well, regaining weight and has returned back to home. At 6 months follow up, patient, once deemed incurable, has been restored to normal life and off any treatment.

Gastrointestinal cancers impact the large intestine GI tract and the digestive system including Oesophagus, stomach, small and large intestines, liver, gallbladder, pancreas, etc. Amongst these cancers, colorectal cancer has the best outcomes with treatment stage by stage. Colorectal cancers originate from any part of the large intestine in the abdomen as ulcers or masses and can metastasize to the other parts if not detected timely. Most patients with even widespread colorectal cancer live long productive lives with modern treatment and some can even be cured. Awareness is our biggest weapon in our fight against colorectal cancer. There is a need to be aware of the early symptoms of colorectal cancer and ensure use of colonoscopy for early detection of colorectal cancer. Delayed diagnosis leads to prolonged treatment which leads to increase in cost and poorer outcomes.