LAUSR

BACKGROUND Laparoscopic-assisted or open extended right hemicolectomy (RC) plus pancreaticoduodenectomy (PD) has recently been reported.(1, 2) A less invasive alternative with better surgical outcomes is pure laparoscopic surgery,(3) which is expected to resolve impaired wound healing caused by targeted drugs that can delay subsequent systemic therapies. METHODS This video presents the first case of pure laparoscopic RC+PD via caudal approach after chemotherapy and targeted drug translational treatment. RESULTS A 73-year-old female patient was diagnosed with hepatic flexure carcinoma that infiltrated the pancreas and duodenum with a single liver metastasis. After five courses of oxaliplatin plus capecitabine (XELOX) and three courses of bevacizumab transformation, RC+PD was performed. Radiofrequency therapy for a liver lesion was planned to achieve radical treatment. First, a conventional laparoscopic radical RC was completed, and the location and depth of pancreaticoduodenal invasion was evaluated. Upward separation was continued along the caudal approach, and PD was subsequently completed. It was found ideal for most complex pancreaticojejunostomy procedures to align the longitudinal axis of the instrument used perpendicular to the pancreas. The entire tumour was eventually removed from the abdominal wound at the stoma site, and an ileostomy was formed to prevent anastomotic leakage associated with the targeted drug.(4) Pathological examination revealed a moderately differentiated adenocarcinoma that directly invaded the entire duodenum (T4bN0M1a). Following the Becker criteria for tumour regression grading (TRG),(5) the tumour was assessed as TRG3 grade. No cancer cells were found at all surgical margins and in all 40 lymph nodes were examined histologically. The patient recovered well without any complications and was discharged on the 25th postoperative day, with a total hospital stay of 41 d. At present, our patient continues to receive adjuvant chemotherapy with XELOX and an oncology follow-up. CONCLUSION Reasonable surgical design and effective translational therapy allowed radical resection via laparoscopy. Moreover, the minimally invasive approach not only shortened the hospital stay and reduced blood loss and pain, it also guaranteed successful treatment of the radiofrequency therapy in our case.