Feasibility and safety of surgical strategy based on tumor characteristics and location in laparoscopic and endoscopic cooperative surgery for non-ampullary duodenal tumors

BACKGROUND AND AIM: Recently, several studies have demonstrated the safety and feasibility of laparoscopic and endoscopic cooperative surgery for duodenal tumors (D-LECS). However, the standard procedure for D-LECS has not been established. Herein, we introduce the feasibility and safety of a surgical strategy based on tumor characteristics and location in D-LECS. METHODS: This retrospective single-center study included 17 consecutive patients with duodenal tumors who underwent D-LECS between October 2017 and November 2023. RESULTS: Two, 13 and 2 tumors were located in the first, second and third portions of the duodenum, respectively. Three tumors were protruded type and 14 were superficial type. The median tumor size was 25 (6-45) mm. Supracolic, mesenteric and inferior approaches were employed in 14, 2 and 1 case, respectively, during D-LECS. Laparoscopic reinforcement after endoscopic submucosal dissection (ESD) (D-LECS with ESD), laparoscopic suturing after full-thickness resection (FTR) (D-LECS with FTR) and Closed-LECS were performed in 13, 2 and 2 cases, respectively. The median operation time and blood loss were 237 (159-420) min and 0 (0-75) ml, respectively. En-bloc pathological curative resection was achieved in all cases. Two patients had paralytic ileus and delayed gastric emptying as postoperative complications. The median duration of postoperative hospital stay was 10 (6-22) days. One local recurrence was observed in a case of adenocarcinoma in situ during the median follow-up of 13 (2-71) months. CONCLUSIONS: The feasibility and safety of our surgical strategy based on the tumor characteristics and location were demonstrated in D-LECS.