Clinicopathological features and management strategy for superficial nonampullary duodenal tumors: a multi-center retrospective study

Abstract

Purpose: We investigated the clinicopathological features and management for superficial nonampullary duodenal tumors (SNADTs). The safety and feasibility of laparoscopic management, especially laparoscopic endoscopic cooperative surgery (LECS), were evaluated.

Methods: A total of 59 patients with SNADTs who underwent operations from January 2009 to December 2018 at all 8 institutions of the Catholic Medical Center were identified in our comprehensive multi-institutional database. Clinicopathological and surgical data on the 4 anatomical regions of the duodenum were collected and compared. Characteristics of conventional laparoscopic procedure (laparoscopy-only) and LECS procedures were also compared.

Results: There were significantly more asymptomatic patients with tumors in the first and second vs. third and fourth duodenal regions. Gastrointestinal stromal tumors (GISTs), carcinoids, and ectopic pancreatic tumors were identified in 32, 12, and 5 cases, respectively. Forty-two patients (71.2%) underwent laparoscopy. Of patients undergoing laparoscopy, the LECS group exhibited significantly more endophytic features and smaller tumor sizes (P < 0.001 and P < 0.001, respectively). Although no significant difference in the wedge resection or postoperative complication rate was seen between the 2 groups (P = 0.096 and P = 0.227, respectively), the wedge resection rate was higher, and the complication rate lower, in the LECS group than the conventional laparoscopic surgery group.

Conclusion: Most of the SNADTs located in proximal duodenum were detected incidentally. GISTs were the most common diagnoses of SNADTs in all locations. In treating these tumors, laparoscopic resection is safe and feasible. Especially, LECS may be ideal for treating small endophytic tumors, minimizing over-resection and postoperative complications.

Keywords: Duodenal neoplasm; Endoscopy; Laparoscopy; Surgery.

Fig. 1. (A) Tumor located in the first duodenal region. (B) Tumor located in the second region. (C) Tumor located in the third region. (D) Tumor located in the fourth region.

Fig. 2. (A) Tumor location was confirmed laparoscopically and by intraluminal endoscopic illumination. (B–D) Endoscopists performed full-thickness resections. (E) After the tumor had been fully exposed by the surgeon, it was resected using an energy device. (F) The edge of the incision line on the duodenum was closed after tumor resection using hand-sewn sutures or the endovascular gastrointestinal anastomosis (Endo-GIA) stapler.

Fig. 3. Schematic illustration of the relationship between tumor location and pathological diagnosis. GIST, gastrointestinal stromal tumor.