Feasibility and Safety of a Novel Laparoscopic and Endoscopic Cooperative Surgery Technique for Superficial Duodenal Tumor Resection: How I Do It
Pancreatoduodenectomy is considered to be a very invasive treatment for early superficial duodenal tumors (SDTs), which have a lower risk of lymph node metastasis. Partial resection of the duodenum with endoscopic submucosal dissection for SDT resection is an attractive technique but it is associated with a high risk of complications. We describe our technique for SDT resection.
It includes the following elements: freeing the transverse mesocolon, exposing and mobilizing the second part of the duodenum and the head of the pancreas (Kocher maneuver), confirming the location of the ulcer bed for endoscopic submucosal dissection, and laparoscopic suturing by hand in the seromuscular layer of the duodenum. We performed this technique in 10 patients between March 2015 and March 2017.
The median tumor diameter and resected tissue diameter were 36 (20–54) and 41 (25–60) mm, respectively. Curative resection (R0) with negative margins was achieved for all patients. There were no conversions to open surgery in this series. No postoperative complications were above grade 2 in the Clavien-Dindo classification system. No recurrences were observed during the medium-term follow-up period.
This technique is safe and feasible and can be an option for surgical SDT resection.
KeywordsDuodenal tumor Laparoscopic and endoscopic cooperative surgery LECS
Yoshitomo Yanagimoto designed the study and wrote the initial draft of the manuscript. Takeshi Omori contributed to the analysis of data and interpretation of results and assisted in the preparation of the manuscript. All other authors contributed to data collection and interpretation of results and critically reviewed the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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