Abstract
Background
Duodenal subepithelial lesions (D-SELs) are rare and their resection is challenging. Unfortunately, data on surgical and endoscopic resection of D-SELs are scarce. This study aimed to assess the safety and efficacy of surgical resection and endoscopic resection (ER) for D-SELs.
Methods
We retrospectively analyzed clinical data of patients with non-ampullary D-SELs who underwent ER or surgery and compared the outcomes between ER and surgery with no/low-risk SELs over 15 mm from March 2010 to August 2020. Clinicopathologic findings, procedure-related parameters, and follow-up data were analyzed.
Results
A total of 107 patients (108 lesions) were enrolled; 52 patients (53 lesions) received ER and 55 patients (55 lesions) received surgery. In ER group, en bloc resection rate and R0 resection rate were 94 and 89%, respectively. Major adverse events rate was 6%. One (2%) patient experienced local recurrence. In surgery group, R0 resection was achieved in all cases. Major adverse events rate was 20%. Recurrence rate and distant metastases rate were 4 and 8%, respectively. One (2%) patient died from septicemia during follow-up. Thirty-three patients in each group were enrolled in the comparison. There were no significant differences in age, sex, lesion size and location (P > 0.05). More histologically GISTs and muscularis propria-originated lesions were treated by surgery (P < 0.05). ER was significantly associated with a shorter operation time, shorter hospital stay, lower cost, less estimated blood loss, and lower major adverse events rate compared to the surgery group (P < 0.05). However, R0 resection rate, mortality, recurrence rate, and metastases rate were not significant different (P > 0.05).
Conclusions
ER is an effective and safe treatment modality for selected patients with non-ampullary D-SELs by expert endoscopists. Surgery is a radical method for D-SELs that should be reserved for D-SELs not amenable to ER.
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References
Cho JW, Korean ESD Study Group (2016) Current guidelines in the management of upper gastrointestinal subepithelial tumors. Clinical endoscopy 49:235–240
Reddymasu SC, Oropeza-Vail M, Pakseresht K et al (2012) Are endoscopic ultrasonography imaging characteristics reliable for the diagnosis of small upper gastrointestinal subepithelial lesions? J Clin Gastroenterol 46:42–45
Gaspar JP, Stelow EB, Wang AY (2016) Approach to the endoscopic resection of duodenal lesions. World J Gastroenterol 22:600–617
Delle Fave G, O’Toole D, Sundin A et al (2016) ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendocrinology 103:119–124
Shamali A, McCrudden R, Bhandari P et al (2016) Pancreaticoduodenectomy for nonampullary duodenal lesions: indications and results. Eur J Gastroenterol Hepatol 28:1388–1393
Lu C, Jin W, Mou Y et al (2020) Optimal laparoscopic management and oncological outcomes of gastrointestinal stromal tumors in duodenum: pancreaticoduodenectomy or pancreas-sparing duodenectomy? Cancer Manag Res 12:4725–4734
Dasari BVM, Al-Shakhshir S, Pawlik TM et al (2018) Outcomes of surgical and endoscopic resection of duodenal neuroendocrine tumours (NETs): a systematic review of the literature. J Gastrointest Surg 22:1652–1658
Zhou Y, Wang X, Si X et al (2020) Surgery for duodenal gastrointestinal stromal tumor: a systematic review and meta-analysis of pancreaticoduodenectomy versus local resection. Asian J Surg 43:1–8
Du H, Ning L, Li S et al (2020) Diagnosis and treatment of duodenal gastrointestinal stromal tumors. Clin Transl Gastroenterol 11:e00156
Cameron JL, Riall TS, Coleman J et al (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15
Shen Z, Chen P, Du N et al (2019) Pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors: a systematic review and meta-analysis. BMC Surg 19:121
Bartel MJ, Puri R, Brahmbhatt B et al (2018) Endoscopic and surgical management of nonampullary duodenal neoplasms. Surg Endosc 32:2859–2869
Kim TW, Kim GH, Park DY et al (2017) Endoscopic resection for duodenal subepithelial tumors: a single-center experience. Surg Endosc 31:1936–1946
Ye LP, Mao XL, Zheng HH et al (2017) Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases. Surg Endosc 31:1070–1077
Lee SW, Sung JK, Cho YS et al (2019) Comparisons of therapeutic outcomes in patients with nonampullary duodenal neuroendocrine tumors (NADNETs): a multicenter retrospective study. Medicine 98:e16154–e16154
Ren Z, Lin S-L, Zhou P-H et al (2019) Endoscopic full-thickness resection (EFTR) without laparoscopic assistance for nonampullary duodenal subepithelial lesions: our clinical experience of 32 cases. Surg Endosc 33:3605–3611
Gincul R, Ponchon T, Napoleon B et al (2016) Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy 48:979–986
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Tan Y, Tang X, Guo T et al (2017) Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer. Surg Endosc 31:3376–3382
Chok A-Y, Koh Y-X, Ow MYL et al (2014) A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors. Ann Surg Oncol 21:3429–3438
Joensuu H (2008) Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 39:1411–1419
Li C, Chu Y, Lv L et al (2021) Safety and efficacy of endoscopic resection for the treatment of duodenal subepithelial lesions. J Gastrointest Oncol 12:856–863
Zhang H, Liu Q (2020) Prognostic indicators for gastrointestinal stromal tumors: a review. Trans Oncol 13:100812
Zhong Y, Deng M, Liu B et al (2013) Primary gastrointestinal stromal tumors: current advances in diagnostic biomarkers, prognostic factors and management of its duodenal location. Intractable Rare Dis Res 2:11–17
Liu Z, Zheng G, Liu J et al (2018) Clinicopathological features, surgical strategy and prognosis of duodenal gastrointestinal stromal tumors: a series of 300 patients. BMC Cancer 18:563
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(I) Conception and design: CL, DL, and YT, (II) Analysis and interpretation of the data: CL, CL, XW, and ML, (III) Drafting of the article: CL and YT, (IV) Critical revision of the article for important intellectual content: CL, DL, and YT, (V) Final approval of manuscript: All authors.
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Drs. Chen Li, Chengbai Liang, Xuehong Wang, Meixian Le, Deliang Liu, and Yuyong Tan have no conflicts of interest or financial ties to disclose.
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Li, C., Liang, C., Wang, X. et al. Safety and efficacy of surgical and endoscopic resection in the treatment of duodenal subepithelial lesions. Surg Endosc 36, 4145–4153 (2022). https://doi.org/10.1007/s00464-021-08740-3
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DOI: https://doi.org/10.1007/s00464-021-08740-3