56 year old male who developed fatigue and night sweats, with PCP workup showing anemia. Underwent colonoscopy- a fungating infiltrative ulcerated completely obstructing large mass in proximal ascending colon. Biopsy: invasive moderately differentiated adenocarcinoma. He underwent a CT chest/abdomen/pelvis and reported as a diffusely infiltrative, transmural colonic mass in hepatic flexure 8 x 5 cm, regional lymph nodes, suspicious invasion into duodenum; no distant metastasis in chest/abdomen/pelvis - few lung nodules to be monitored, no bowel obstruction. The patient was positioned in the modified lithotomy. First, a straight line port placement was followed from right lower quadrant to the left upper quadrant 8 cm apart and four straight 8 mm trocars were inserted for this purpose. He underwent a Robotic complete mesocolic excision with intracorporeal side-to- side ileocolic anastomosis and resection of locally advanced hepatic flexure colon cancer en bloc with anterior wall of the duodenum and primary repair and closure of the anterior wall of the duodenum with robotic approach. Final pathology: Invasive adenocarcinoma of the hepatic flexure, poorly-differentiated. The carcinoma penetrates the serosa of the colon and infiltrates the serosa and outer muscular wall of the duodenum. Lymphovascular and perineural invasion are identified . One of twenty-nine lymph nodes, positive for metastatic carcinoma (1/29). Complete tumor resection with negative margins (R0) Pathologic Stage: pT4bN1a