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Laparoscopic and endoscopic co-operative surgery for nonampullary duodenal tumors

World Journal of Gastroenterology 2016年第47期22卷 10424-10431页

作者： Daisuke Ichikawa Shuhei Komatsu Osamu Dohi Yuji Naito Toshiyuki Kosuga Kazuhiro Kamada Kazuma Okamoto Yoshito Itoh Eigo Otsuji Division of Digestive Surgery Department of Surgery Kyoto Prefectural University of Medicine Department of Gastroenterology and Hepatology Kyoto Prefectural University of Medicine

AIM To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery(LECS) for early nonampullary duodenal *** 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 *** 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 *** LECS can be a safe and minimally invasive treatment

关键词： non-ampullary tumor Laparoscopic and endoscopic cooperative surgery Early duodenal cancer

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