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Distinct approaches (antecolic and retrocolic) according to tumor location in laparoscopic and endoscopic cooperative surgery for non-ampullary duodenum tumors

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Abstract

Aim

Laparoscopic and endoscopic cooperative surgery for early non-ampullary duodenum tumors (D-LECS) is now noted because of its safety and lower invasiveness. Here, we introduce two distinct approaches (antecolic and retrocolic) according to the tumor location during D-LECS.

Methods

From October 2018 to March 2022, 24 patients (25 lesions) underwent D-LECS. Two (8%), two (8%), 16 (64%), and five (20%) lesions were located in the first portion, in the second portion to Vater’s papilla, around the inferior duodenum flexure, and in the third portion of the duodenum, respectively. The median preoperative tumor diameter was 22.5 mm.

Results

Antecolic and retrocolic approaches were employed in 16 (67%) and 8 (33%) cases, respectively. LECS procedures, such as two-layer suturing after full-thickness dissection and laparoscopic reinforcement by seromuscular suturing after endoscopic submucosal dissection (ESD), were performed in five and 19 cases, respectively. Median operative time and blood loss were 303 min and 5 g, respectively. Intraoperative duodenal perforations occurred in three of 19 cases during ESD; however, they were successfully laparoscopically repaired. Median times until start diet and postoperative hospital stay were 4.5 and 8 days, respectively. Histological examination of the tumors revealed nine adenomas, 12 adenocarcinomas, and four GISTs. Curative resection (R0) was achieved in 21 cases (87.5%). In a comparison of the surgical short outcomes between antecolic and retrocolic approaches, there was no significant difference.

Conclusion

D-LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors, and two distinct approaches according to the tumor location are feasible.

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Abbreviations

EMR:

Endoscopic mucosal resection

LECS:

Laparoscopic and endoscopic co-operative surgery

ESD:

Endoscopic submucosal dissection

GIST:

Gastrointestinal stromal tumor

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Funding

This work was supported by the Japanese Foundation for Research and Promotion of Endoscopy (to H.H.).

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Author notes

  1. Hiromitsu Hayashi and Hideaki Miyamoto have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Hiromitsu Hayashi, Shigeki Nakagawa, Tatsunori Miyata, Masayo Tsukamoto, Kosuke Mima, Hidetoshi Nitta & Hideo Baba

  2. Department of Gastroenterology, Kumamoto University, Kumamoto, Japan

    Hideaki Miyamoto, Kenshi Matsuno & Yasuhito Tanaka

Authors
  1. Hiromitsu Hayashi
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  2. Hideaki Miyamoto
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Contributions

Conceived and designed the study: HH and HM. Performed the procedures: HH, HM, SN, and KM. Analyzed the data: HH and HM. Wrote the manuscript: HH and HM. Collected clinical data: MT, MT, KM, and HN. Provided critical revisions for scientific findings: YH and HB. Organized the paper and approved the final version to be published: HH, HM, YH, and HB.

Corresponding author

Correspondence to Hiromitsu Hayashi.

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Disclosures

Drs. Hiromitsu Hayashi, Hideaki Miyamoto, Shigeki Nakagawa, Kenshi Matsuno, Tatsunori Miyata, Masayo Tsukamoto, Kosuke Mima, Hidetoshi Nitta, Yasuhito Tanaka, and Hideo Baba have no conflicts of interest or financial ties to disclose.

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Hayashi, H., Miyamoto, H., Nakagawa, S. et al. Distinct approaches (antecolic and retrocolic) according to tumor location in laparoscopic and endoscopic cooperative surgery for non-ampullary duodenum tumors. Surg Endosc 37, 6718–6726 (2023). https://doi.org/10.1007/s00464-023-10114-w

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