Risk-Stratified Management of Superficial Non-Ampullary Duodenal Tumors: Outcomes of LECS and Endoscopic Resection

The optimal management of superficial non-ampullary duodenal tumors remains challenging because of heterogeneous pathology, variable invasion depth, and procedure-related risks. This study evaluated the safety and feasibility of laparoscopic and endoscopic cooperative surgery compared with endoscopic resection and explored risk-stratified treatment selection.

We retrospectively reviewed 181 patients with superficial non-ampullary duodenal tumors treated between April 2013 and April 2025, including 148 who underwent endoscopic resection and 33 who underwent laparoscopic and endoscopic cooperative surgery. Clinicopathologic characteristics, operative outcomes, complications, and follow-up results were compared. Firth's penalized logistic regression was used to identify risk factors for endoscopy-related adverse events among epithelial tumors.

Compared with the endoscopic resection group, the laparoscopic and endoscopic cooperative surgery group had deeper tumor invasion and larger specimen size. En bloc resection rates were 95% and 97%, and microscopically margin-negative resection rates were 93% and 97%, respectively. Laparoscopic and endoscopic cooperative surgery required longer operative time and postoperative stay but had a similarly low rate of major complications. Eight patients in the endoscopic resection group required emergent surgical conversion. Among epithelial tumors, tumor size of 20mm or greater was independently associated with endoscopy-related adverse events.

Laparoscopic and endoscopic cooperative surgery is a safe and effective option for selected superficial non-ampullary duodenal tumors, particularly lesions with deeper invasion, larger size, or anticipated technical difficulty. A risk-stratified strategy incorporating tumor size, invasion depth, and histology may improve treatment selection.