Total laparoscopic en bloc right hemicolectomy and pancreaticoduodenectomy with transvaginal specimen extraction for locally advanced right colon cancer: a case report.

For locally advanced right colon cancer (LARCC) invading duodenum, multivisceral resection is a curative surgical treatment, which is technically challenging when performed in a total laparoscopic approach. Herein, we report the first case of LARCC treated by total laparoscopic en bloc right hemicolectomy and pancreaticoduodenectomy with transvaginal specimen extraction. The patient was a 37-year-old female suffering from upper abdominal pain who was diagnosed with LARCC invading the duodenum by preoperative examination. The en bloc resection and digestive tract reconstruction were completed laparoscopically without an assisted abdominal incision. Then the specimen was extracted transvaginally through a 6 cm transverse incision made in the posterior vaginal fornix and the vaginal incision was closed by a continuous suture intracorporeally. The operative time was 470 min and intraoperative blood loss was 130 mL. The postoperative pathological examination showed T4bN0M0 adenocarcinoma of the hepatic flexure of colon with infiltration of duodenal serosa, and all the margins were negative. The patient recovered uneventfully with minimal postoperative pain and was discharged from hospital on postoperative day 7. After 3 years of follow-up, the patient was alive with no recurrence. To the best of our knowledge, this is the most extensive multivisceral resection with natural orifice specimen extraction (NOSE) ever reported. We believe that NOSE surgery, with advantages of minimal invasiveness and enhanced recovery, is a feasible and promising option for LARCC.