Short- and long-term outcomes of laparoscopic endoscopic cooperative surgery for duodenal neoplasms: a retrospective...

Non-ampullary duodenal tumors are relatively rare; however, advancements in esophagogastroduodenoscopy have improved their detection. Endoscopic resection is effective for treating adenomas and early-stage cancers without lymph node involvement. However, challenges include assessing tumor invasion depth, achieving complete resection, and managing postoperative complications such as delayed perforation. Consequently, laparoscopic endoscopic cooperative surgery (D-LECS) was introduced, but data on its long-term outcomes remain limited.

This retrospective study reviewed 18 cases of D-LECS performed between June 2016 and October 2024 at Tonan Hospital. Included patients had non-ampullary duodenal tumors-adenoma, mucosal adenocarcinoma, or neuroendocrine neoplasms-without lymph node involvement. Surgical outcomes, complications, and follow-up data were analyzed.

The median patient age was 65.5 years, and 14 patients were male. Tumors were located in the first (4 cases), second (11 cases), and third (3 cases) portions of the duodenum. The median operative time was 233 min, longer in the reinforcement after endoscopic submucosal dissection group than in the full-thickness resection group (289 vs. 221 min, P = 0.37). A Clavien-Dindo grade ≥ 3a complication occurred only in the first case, involving delayed perforation. The median hospital stay was 12 days. En-bloc and R0 resection rates were 83.3 and 92.9%, respectively. No long-term complications, including stricture or recurrence, were observed over a median follow-up of 37 months.

D-LECS demonstrated favorable short- and long-term outcomes for non-ampullary duodenal tumors, with high en-bloc and R0 resection rates. These findings suggest that D-LECS is a viable treatment option for selected duodenal tumors.