探讨右半结肠癌根治联合胰十二指肠切除术（PD）对局部晚期右半结肠癌的安全性和有效性。

回顾性分析2019年4月至2020年12月北京大学首钢医院收治的5例局部晚期结肠癌行右半结肠癌根治联合PD的患者的临床资料。

5例患者经肠镜活检病理学确诊为结肠腺癌，经影像学评估肿瘤侵犯十二指肠3例，同时侵犯十二指肠及胰腺2例。3例经术前系统治疗后接受手术治疗，2例直接行手术治疗。行右半结肠根治性切除+PD 2例，右半结肠根治性切除+PD+荷包式胃造口1例，右半结肠根治性切除+PD+肠系膜上静脉（SMV）切除重建+隧道式小肠（空肠）插管造口1例，右半结肠根治性切除+PD+SMV重建+胰腺外引流+胆管外引流+小肠外置造口（回肠双腔造口）1例。5例术后均发生胰瘘（生化漏），发生胃排空延迟1例，乳糜漏1例，切口感染1例，Clavien-Dindo分级均为Ⅱ级，无Ⅲ级及以上并发症。术后肝转移2例［2例行程序性死亡受体1（PD-1）治疗］，分别无瘤生存（DFS）17和21个月；术后腹膜转移2例（1例术后化疗，1例未行化疗），总生存（OS）分别为11和12个月；无转移、复发1例，DFS 33个月。

对于局部晚期右半结肠癌，行根治性右半结肠切除联合PD是安全可行的。术后予以辅助治疗可以控制肿瘤进展，延长患者生存期。

To assess the safety and effectiveness of radical resection combined with pancreaticoduodenectomy (PD) for the treatment of locally advanced right colon cancer.

The clinical data of five patients with locally advanced colon cancer who underwent right hemicolectomy combined with PD at Peking University Shougang Hospital from April 2019 to December 2020 were analyzed retrospectively.

All the five patients were pathologically diagnosed as having colon adenocarcinoma. According to imaging evaluation, the tumor invaded the duodenum in three cases and invaded the duodenum and pancreas in two. Three cases received surgical treatment after preoperative systemic treatment, and two received surgical treatment directly. Radical resection of the right colon + PD was performed in two cases, radical resection of the right colon + PD + purse string gastrostomy in one, radical resection of the right colon + PD + resection and reconstruction of the superior mesenteric vein (SMV) plus tunnel small intestinal (jejunum) intubation in one, and radical resection of the right colon + PD + SMV reconstruction + external drainage of the pancreas + external drainage of the bile duct + external enterostomy of the small intestine (double lumen ileum) in one. Pancreatic fistula (biochemical leakage) occurred in all the five cases, delayed gastric emptying in one, chylous leakage in one, and incision infection in one. All postoperative complications were grade Ⅱ according to the Clavien-Dindo classification, and there were no complications of grade Ⅲ or above. There were two cases with liver metastasis after operation (both were treated with programmed death protein 1 (PD-1)), and their disease-free survival (DFS) was 17 and 21 months, respectively. Postoperative peritoneal metastasis occurred in two cases (one received postoperative chemotherapy and one did not receive chemotherapy), and their overall survival (OS) was 11 and 12 months, respectively. There was no metastasis or recurrence in one case, and the DFS was 33 months.

Radical right colon resection combined with PD is safe and feasible for locally advanced right colon cancer. Postoperative adjuvant therapy can control tumor progression and prolong the survival of patients.