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. 2014;5(12):1021-4.
doi: 10.1016/j.ijscr.2014.10.051. Epub 2014 Oct 31.

Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: Report of a case

Takaaki Tsushimi  1 , Hirohito Mori  2 , Takasuke Harada  2 , Takashi Nagase  2 , Yoshitaka Iked  2 , Hiromo Ohnishi  3
Affiliations

Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: Report of a case

Takaaki Tsushimi et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: We report a case of duodenal neuroendocrine tumor (NET) G1 resected by laparoscopic and endoscopic cooperative surgery (LECS) technique.

Presentation of case: A 58-year-old woman underwent esophagastroduodenoscopy, revealing an 8-mm, gently rising tumor distal to the pylorus, on the anterior wall of the duodenal bulb. Endoscopic ultrasonography suggested the tumor might invade the submucosal layer. The tumor was pathologically diagnosed as a G1 duodenal NET, by biopsy. Endoscopic submucosal dissection was attempted, but was unsuccessful because of the difficulty of endoscopically performing an inversion operation in the narrow working space. The case was further complicated by the patient's duodenal ulcer scar. We performed a full-thickness local excision using laparoscopic and endoscopic cooperative surgery. The tumor was confirmed and endoscopically marked along the resection line. After full-thickness excision, using endoscopy and laparoscopy, interrupted full-thickness closure was performed laparoscopically.

Discussion: Endoscopic treatment is generally recommended for G1 NETs <10mm in diameter and extending only to the submucosal layer. However, some cases are difficult to resect endoscopically because the wall of duodenum is thinner than that of stomach, and endoscope maneuverability is limited within the narrow working space. LECS is appropriate for early duodenal G1 NETs because they are less invasive and resection of the lesion area is possible.

Conclusion: We demonstrated that LECS is a safe and feasible procedure for duodenal G1 NETs in the anterior wall of the first portion of the duodenum.

Keywords: Carcinoid; Duodenal NET G1; Laparoscopic and endoscopic cooperative surgery (LECS).

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Figures

Fig. 1
Fig. 1
(a) Esophagastroduodenoscopy showing an 8-mm diameter submucosal tumor in the anterior wall of duodenal bulb, located just behind of pyloric ring of the stomach. (b) Endoscopic ultrasonography demonstrating a homogeneous, hypoechoic lesion, located mainly within the submucosal layer.
Fig. 2
Fig. 2
(a) Full-thickness excision along the marked dissection line using a Dual knife and insulation-tip-knife2. (b) A post-excisional defect in the anterior duodenal wall. (c) The post-excisional is sutured with an interrupted, full-thickness closure, laparoscopically. (d) The endoscope passes the suture site easily; no air leakage was detected despite insufflation of the duodenum.
Fig. 3
Fig. 3
(a) A pathological examination reveals small, nearly homogeneous neoplastic cells, with round or oval nuclei and rich cytoplasms; they are arranged in an alveolar or cord-like proliferation pattern (hematoxylin–eosin staining, ×400). Positive immunostaining for chromogranin (b, ×400) and synaptophysin (c, ×400).
Fig. 4
Fig. 4
A postoperative contrast study shows no stasis or stenosis at the suture site.
See this image and copyright information in PMC

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