Successful treatment of duodenal carcinoid tumor by laparoscopy‐assisted endoscopic full‐thickness resection with lymphadenectomy

Abstract

Reports on endoscopic full-thickness resection of the duodenum using the endoscopic submucosal dissection technique are rare. Here we present a case of a duodenal bulb carcinoid tumor successfully treated by laparoscopy-assisted endoscopic full-thickness resection (LAEFR). An asymptomatic 65-year-old woman had a 10-mm, submucosal tumor on the anterior wall of the duodenal bulb. Abdominal CT revealed an enlarged lymph node adjacent to the duodenum and pancreas. Although we informed the patient of the need for pancreatoduodenectomy with a lymphadenectomy, the patient expressly requested LAEFR. After negative nodal metastasis was confirmed by an intraoperative frozen section of the enlarged nodes, LAEFR was performed using the endoscopic submucosal dissection technique under the laparoscopic assistance. The duodenal wall defect was closed by laparoscopy with an Albert anastomosis. The entire circumferential margin of the specimen was histopathologically negative for carcinoid tumor cells. In summary, LAEFR enables en bloc and whole-layer excision of nonperiampullary duodenal lesions with a sufficient surgical margin, both vertically and laterally. LAEFR is a minimally invasive and effective treatment for selected patients with duodenal carcinoid tumor.

Feasibility of Endoscopy-Assisted Laparoscopic Full-Thickness Resection for Superficial Duodenal Neoplasms

“…Duodenal neoplasms are rare and the standard treatment for nonampullary duodenal tumor has not been established [14, 15, 19, 20]. Local resection of nonampullary duodenal tumor using endoscopic submucosal dissection technique and laparoscopy has been described only in two case reports [14, 15].…”

“…Local resection of nonampullary duodenal tumor using endoscopic submucosal dissection technique and laparoscopy has been described only in two case reports [14, 15]. This is the first report on a large number of cases of resection using combined endoscopy and laparoscopy.…”

“…To overcome these problems, a new procedure called laparoscopy-assisted endoscopic full-thickness resection (LAEFR) using ESD technique has been proposed and reported in two case reports [14, 15]. This procedure involves several steps including endoscopic observation of the tumor within the duodenal lumen, marking around it, incising the peritumoral mucosa and submucosa by ESD technique using a needle knife, perforating the muscular layer in the incision line, and performing a full-thickness incision using an IT knife under laparoscopic supervision.…”

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

“…Meanwhile, ESD has a higher complication risk [28], and open surgery has a potential of higher morbidity and mortality [29]. To resolve these problems, a minimally invasive surgery for NAD-NETs, such as laparoscopic and endoscopic cooperative surgery and endoscopy-assisted laparoscopic full-thickness resection, has been recently reported [30,31,32]. These new procedures are likely to be safe and feasible for NAD-NETs in the anterior wall of the first and second portion of the duodenum.…”

Novel technique of endoscopic full-thickness resection for superficial nonampullary duodenal neoplasms to avoid intraperitoneal tumor dissemination

“…On the other hand, surgical treatment of such lesions often results in extensive resections, causing significant morbidity. Recently, laparoscopic and/or endoscopic full-thickness resection (FTR) has been reported to be a useful technique for the treatment of nonampullary SDNs 3 4 5. Despite their minimally invasive nature, all FTR procedures are associated with the possibility of intraperitoneal tumor dissemination.…”