Challenges of the Multidisciplinary Approach to Synchronous Duodenal and Cecal Adenocarcinomas
Summary
This on-demand teaching session, led by Răzvan-Gabriel Pantilie and colleagues, provides an in-depth look at a challenging medical case involving duodenal and cecal adenocarcinomas. The presentation thoroughly explores the various complexities associated with these two rare gastrointestinal cancer types. Viewers will gain insight into the unique treatment strategies employed in this case, including neoadjuvant chemotherapy and multiple surgical interventions, as well as the ongoing debates surrounding the best therapeutic approaches for such rare conditions. This session will be especially valuable for medical professionals interested in deepening their understanding of these cancers and their associated treatment options.
Learning objectives
- Understand the complexities and challenges associated with the multidisciplinary approach to synchronously managing two rare cancers such as duodenal and cecal adenocarcinomas.
- Review the presentation, diagnosis, and therapeutic options, including R0 surgical resection and systemic chemotherapy, for patients with duodenal and cecal adenocarcinomas.
- Analyze the effectiveness and applicability of neoadjuvant chemotherapy, specifically FOLFOXIRI, in stabilizing duodenal tumors and managing cecal tumors.
- Discuss the surgical procedures used for treatment, including emergency side-to-side gastro-entero anastomosis, extended right hemicolectomy with iso-peristaltic side-to-side ileocolic anastomosis, segmental resection of D3-D4 duodenum, and feeding jejunostomy.
- Evaluate the importance of genetic testing in gaining insights into the etiology of simultaneous occurrence of two rare types of cancers.
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Challenges of the Multidisciplinary Approach to Synchronous Duodenal and Cecal Adenocarcinomas‚ A Case Report Author: Răzvan-Gabriel PANTILIE 1 Coauthors: Ioana-Daria PAVĂL, Albert PETRE, Sebastian-Romeo PINTILIE, Cezara POP, Iulia-Cezara POP, Aniela POPESCU 1 2 Coordinators: Dr Ciprian CUCOREANU Affiliations: 1- ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca 2- Emergency County Clinical Hospital, Cluj-Napoca INTRODUCTION CASE PRESENTATION 52-years-old male patient presents with: Duodenal adenocarcinoma is a rare and aggressive malignant condition, accounting for less than 0.5% of all gastrointestinal cancers. Additionally, cecal adenocarcinoma asthenia Progressively weight loss developed over represents one fifth of all colorectal cancers and has a poor dyspeptic syndrome approximately one prognosis in advanced stages. Existing therapeutic options hematochezia year include R0 surgical resection with lymphadenectomy and systemic chemotherapy. Physical exam: Firm, mobile mass of about 4 cm in the right flank of the abdomen Preoperative imaging assessment: thoraco-abdomino-pelvic computed tomography (CT), TREATMENT magnetic resonance imaging (MRI) upper and lower digestive endoscopic ultrasound with biopsy Diagnoses: Neoadjuvant Chemotherapy: Stenosing Duodenal Adenocarcinoma located at D3/D4 6 cycles of FOLFOXIRI (folinic acid, fluorouracil, irinotecan, oxaliplatin), initiated 8 months prior. Duodenal tumor (T3N1M0), synchronous with a Cecal Adenocarcinoma (c T3N2M0) remained stable, Cecal tumor increased. Surgery: Emergency side-to-side gastro-entero anastomosis in omega loop configuration, antecolic DISCUSSIONS Extended right hemicolectomy with iso-peristaltic side-to- side ileocolic anastomosis and D3 lymphadenectomy, segmental resection of D3-D4 duodenum with end-to-side Characteristics of this case: duodenojejunal anastomosis, and feeding jejunostomy rarity of double gastrointestinal localization of two types Outcome: of cancers → no established consensus on guidelines FOLFOXIRI → the guideline for colorectal cancer, but not The postoperative gastrointestinal tract configuration resembles a Roux-en-Y, with the limb formed by the efficient in this case. duodenojejunal anastomosis; the patient also had a Multiple surgical treatments were available, and limited resection was chosen instead of previous Billroth II configuration anastomosis. pancreaticoduodenectomy Discharged in good general condition, afebrile, with resumed intestinal transit for liquids and solids, good food Genetic testing is of significant interest to gain further tolerance, and a clean surgical wound healing by primary insights into the etiology intention Intraoperatory picture from the second operation References