Laparoscopic segmental resection for tumours of the Angle of Treitz: a challenging but feasible surgical option. Results from a retrospective case-series analysis

Abstract

Tumours of the small intestine are rare and account for about 5% of gastrointestinal tract neoplasms. The angle of Treitz (AT) could be defined as the intestinal loop comprised between the third duodenal portion and the first 10 cm of jejunum. A gold standard surgical treatment for AT neoplasm has not yet been well defined. This paper is focused on a very rare disease and at the best of our knowledge this is the largest case series in the literature about the Laparoscopic Segmental Resection (LSR) of AT tumours. Using a prospectively collected database, all data of consecutive patients, from January 2007 to May 2019, who underwent LSR for AT tumours at two different institutions were analysed. Patients’ demographics, intra and post-operative data, 30-day mortality and overall survival were collected. A total of 16 patients were retrieved from our database. The mean operative time was 206,5 ± 79 min. Conversion to open surgery was needed in two cases due to tumor size and, respectively, invasion of the transverse colon which required a multivisceral resection. The mean distal and proximal resection margins were 7.4 ± 2.2 and 3.9 ± 1.2 cm. The median number of harvested nodes was 9 ± 3. Pathological diagnosis was GIST in 11 cases, adenocarcinoma in 4 and sarcoma in 1 case. In conclusion, in experienced hands, LSR appears to be a safe and effective treatment option for tumours of the AT. Prospective studies are needed to confirm these findings.

Totally laparoscopic resection using delta-shaped anastomosis of jejunal leiomyosarcoma with intussusception at the angle of Treitz: a case report

“…Especially, the superior mesenteric artery, superior mesenteric vein, and the confluence of the inferior mesenteric and splenic veins are close by, and the duodenojejunal junction is firmly adherent to the retroperitoneum. Therefore, there is a risk of injuring these major vessels and the intestine during mobilization around the ligament of Treitz [7,18]. In the present case, an intracorporeal delta-shaped anastomosis was performed.…”

“…Contrarily, there have been some reports of totally laparoscopic surgery for tumors of the angle of Treitz [7,18]. Tanaka et al and Bracale et al have reported a case of a GIST at the angle of Treitz that was treated with totally laparoscopic resection, followed by an intracorporeal duodenojejunostomy between the second or third duodenal portion and the jejunum [7,18]. They considered this procedure as technically demanding due to the anatomical complexity around the ligament of Treitz [7].…”

Adenocarcinoma of the duodenojejunal angle (The Angle of Treitz): Diagnostic and therapeutic difficulties: About 02 cases

“…This non-specific nature of the symptoms makes that the diagnosis is often late, moreover, in our second patient the tumor was palpable at the time of diagnosis. The localization at the angle of Treitz presents another diagnosis problem, which is the inaccessibility of the area by methods conventional endoscopy makes the diagnosis difficult [3,8,9]. barium meal radiography of the digestive tract is useful for detecting endoluminal diseases.…”

“…Barium meal radiography of the digestive tract is useful for detecting endoluminal diseases [4], CT enteroclysis using spiral and multidetector-row CT with an enteral contrast agent has become the radiographic diagnostic tool of choice for suspected small bowel neoplasms because the sensitivity and specificity are 100% and 95%, respectively. gives useful information regarding the location and the anatomical relationships between the mass and the surrounding structures, including vascular infiltration and invasion of adjacent organs [4,9]. However, Biopsy is accepted as gold standard for diagnosing gastrointestinal tumours and it could be useful to properly plan a surgical approach with radical intent [9].…”

“…gives useful information regarding the location and the anatomical relationships between the mass and the surrounding structures, including vascular infiltration and invasion of adjacent organs [4,9]. However, Biopsy is accepted as gold standard for diagnosing gastrointestinal tumours and it could be useful to properly plan a surgical approach with radical intent [9]. Thus, However, the optimal examination method is capsule endoscopy or endoscopy using a tube capable of reaching the angle of Treitz [4].…”