Efficacy of Laparoscopic and Endoscopic Cooperative Surgery Compared to Endoscopic Resection for Duodenal Tumor...

This study aimed to clarify the safety and feasibility of duodenal laparoscopy-endoscopy cooperative surgery (D-LECS) by comparing the short-term results of D-LECS to those of endoscopic resection (ER) with respect to the rate of some oncological problems.

This single-center retrospective study included 30 patients with duodenal tumors who underwent ER or D-LECS between March 2013 and March 2023. Fifteen patients underwent D-LECS and 15 underwent ER (EMR, ESD, or hybrid ESD), including two that were observed laparoscopically without any procedure, such as suturing.

Two patients in the D-LECS group underwent open surgery to avoid injury to the ampulla of Vater. Between D-LECS and ER, the operation time was significantly longer in the D-LECS group (p = 0.0003), but the endoscopy time was similar (p = 0.25). The postoperative hospital stay was similar in these two groups (p = 0.38). The rate of complication (Clavien-Dindo classification ≥ grade II) was significantly higher in the ER group than that in the D-LECS group (p = 0.031). Regarding oncological problems, there were some cases of piecemeal resection and positive resection margins in both groups, which were not significantly different. One patient in both groups had tumor recurrence, and one died of duodenal cancer in the D-LECS group who refused additional surgery for pathologically positive margins.

D-LECS is a promising procedure with better results and a lower complication rate than ER. However, the indications and feasibility of D-LECS for each patient should be carefully considered.