Laparoscopic and endoscopic cooperative surgery for non-ampullary duodenal epithelial neoplasms

Abstract

Aim: We herein describe our initial experience of laparoscopic and endoscopic cooperative surgery (LECS) for nonampullary duodenal epithelial neoplasms (NADENs) and reveal its clinical significance.Methods: This study included 5 consecutive patients treated by LECS for NADENs between April 2015 and January 2016 in our hospital. For surgery, R0-resection of NADENs was accomplished by endoscopic submucosal dissection (ESD), and the mucosal defect resulting from ESD was subsequently repaired by laparoscopic seromuscular suture and endoscopic clipping. Clinical records were reviewed retrospectively.Results: LECS was accomplished in four patients. There was a case of open conversion due to the relatively large mucosal defect resulting from ESD. In the postoperative course, no serious complications, including intra-and postoperative bleeding and delayed perforation, were noted. The duodenal stenosis occurred in the case of open conversion but was treated by repeated endoscopic balloon dilatation. Of the five lesions of NADENs, there were three adenomas and two adenocarcinomas confined in the mucosa. To date, no tumor recurrence was observed during the postoperative course. Conclusion:LECS is a promising procedure of choice in the treatment of NADENs, facilitating early resumption of both food intake and full daily activity in the postoperative course.

Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

“…The latest endoscopic treatment is laparoscopic-assisted endoscopic full-thickness resection or laparoscopic endoscopic cooperative surgery (LECS). 22 There are several variations of these methods; (1) full thickness marking performed by endoscopy followed by laparoscopic local resection, (2) partial or circumferential full-thickness resection performed by endoscopy followed by laparoscopic local resection, and (3) a duodenal ESD followed by laparoscopic suture of the ESD ulcer. For NADCs, the first two methods may have a risk of cancer dissemination because the lumen is exposed to the peritoneal cavity, thus, nowadays it is applied to small neuroendocrine tumors.…”

“…Promising results have been reported for NADETs sized approximately 30 mm in diameter and located at least 10 mm away from the Vater' s papilla. 22 In contrast, the lesions located near the Vater's papilla or lesions larger than 40 mm are not candidates because of the risk of post-operative stricture and pancreatic fluid fistula.…”

“…The merits of D-LECS are that for 100% of en bloc cases, R0 resection can be theoretically achieved with no major complications. Promising results have been reported for NADETs sized approximately 30 mm in diameter and located at least 10 mm away from the Vater’s papilla [ 22 ].…”