Successful treatment of large adenoma extending close to the papilla in the duodenum by laparoscopy‐assisted pancreas‐sparing duodenectomy

Abstract

A 54-year-old man had a 65-mm infrapapillary, circular, and laterally spreading tubular adenoma in the distal second and proximal third parts of the duodenum. The papilla was 15 mm from the proximal margin of the tumor. Because the patient requested organ-preserving laparoscopic surgery, we conducted laparoscopy-assisted pancreas-sparing duodenectomy (LAPSD). LAPSD consists of five major procedures: (i) laparoscopic wide Kocher maneuver and transection of the proximal jejunum; (ii) laparoscopic separation of the duodenum from the pancreas; (iii) creation of a small upper median laparotomy; (iv) extracorporeal completion of the segmental duodenectomy; and (v) extracorporeal intestinal reconstruction. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. Histopathological examination revealed that the circumferential margin of the specimen was negative for tumor cells. LAPSD provided a clear margin without damaging the papilla and eliminated the possibility of peritoneal or port-site seeding of tumor cells because part of the procedure was performed extracorporeally. LAPSD is a useful alternative to pancreatoduodenectomy in patients with a large adenoma extending close to the papilla in the duodenum.

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

“…Laparoscopic[3,16] and laparoscopic-assisted[23] approaches to distal duodenal resection have also been described and may offer patients the expected benefits of minimally invasive surgery. However, an open approach may be better to achieve adequate assessment and margins for lesions close to the papilla.…”

Laparoscopic pancreas‐preserving duodenectomy: Minimally invasive surgery for superficial nonampullary duodenal epithelial tumors

“…LPPD is technically demanding and only a few cases have been reported 7,8 . However, skilled surgeons in proficient laparoscopic teams routinely performing advanced laparoscopic surgeries can safely execute the procedure.…”

“…LPPD is technically demanding and only a few cases have been reported. 7,8 However, skilled surgeons in proficient laparoscopic teams routinely performing advanced laparoscopic surgeries can safely execute the procedure. The most important point to ensure the safety of the procedure is to first separate the jejunum and then move the duodenal side to the right of the SMA.…”

Laparoscopy‐assisted full‐thickness resection of the duodenum for patients with gastrointestinal stromal tumor with ulceration

“…Totally laparoscopic local full‐thickness resection without a linear stapler (i.e. laparoscopic resection by opening the duodenum under aeroperitoneum and closure by intracorporeal sutures) and laparoscopic‐endoscopic cooperative surgery may pose a significant risk of peritoneal seeding of tumor cells . Tumor cells may spill into the peritoneal cavity during these procedures, leading to tumor cell seeding .…”