Clinical Trials Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2016; 22(47): 10424-10431
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10424
Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors
Daisuke Ichikawa, Shuhei Komatsu, Osamu Dohi, Yuji Naito, Toshiyuki Kosuga, Kazuhiro Kamada, Kazuma Okamoto, Yoshito Itoh, Eigo Otsuji
Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 6028566, Japan
Osamu Dohi, Yuji Naito, Kazuhiro Kamada, Yoshito Itoh, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 6028566, Japan
Author contributions: Ichikawa D, Komatsu S and Dohi O designed the study, performed the operations, and contributed equally to this work; all of other authors followed up the patients and collected the clinical data; Ichikawa D wrote the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Kyoto Prefectural University of Medicine.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daisuke Ichikawa, MD, PhD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 6028566, Japan. ichikawa@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: July 29, 2016
Peer-review started: August 1, 2016
First decision: September 28, 2016
Revised: October 10, 2016
Accepted: November 13, 2016
Article in press: November 13, 2016
Published online: December 21, 2016
Abstract
AIM

To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors.

METHODS

Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique.

RESULTS

Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient.

CONCLUSION

LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.

Keywords: Non-ampullary tumor, Laparoscopic and endoscopic cooperative surgery, Early duodenal cancer

Core tip: We performed laparoscopic and endoscopic co-operative surgery (LECS) procedures, such as full-thickness dissection for submucosal tumors and laparoscopic reinforcement after endoscopic submucosal dissection for epithelial tumors, for 13 early duodenal lesions in 12 patients, and analyzed the safety and feasibility of LECS for early non-ampullary duodenal tumors. All lesions were successfully resected en bloc. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient. LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.