The retrospective single-center study analyzed data from 30 patients treated between March 2013 and March 2023. Of these, 15 patients underwent D-LECS, while the remaining 15 received ER, which included endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or a hybrid ESD approach. In two ER cases, procedures were observed laparoscopically without any intervention such as suturing.
The study revealed the following findings:
- Two patients in the D-LECS group required conversion to open surgery to avoid potential injury to the ampulla of Vater.
- The overall operation time was significantly longer for the D-LECS group.
- Endoscopy time was similar between the D-LECS and ER groups.
- The length of postoperative hospital stay was comparable in both groups.
- The ER group had a significantly higher rate of moderate-to-severe complications (Clavien–Dindo grade II or higher) compared to the D-LECS group.
- Piecemeal resections and positive resection margins were observed in both groups, with no significant difference.
- One patient in each group experienced tumor recurrence.
- In the D-LECS group, one patient with positive resection margins who refused additional surgery later died of duodenal cancer.
The findings highlight the potential benefits of D-LECS in managing duodenal tumors, especially in terms of safety and procedural outcomes. However, the authors emphasize the importance of individualized evaluation to determine whether D-LECS is suitable for each patient, as factors such as tumor location and risk of complications must be considered.
"Overall, the study supports D-LECS as an effective alternative to ER, offering improved safety without compromising oncological outcomes, and highlights the need for further research to refine patient selection criteria," the authors concluded.
Reference:
Shindo, K., Ohuchida, K., Nagasue, T., Ogino, H., Horioka, K., Moriyama, T., Nagayoshi, K., Mizuuchi, Y., Ikenaga, N., Nakata, K., Oda, Y., & Nakamura, M. (2024). Efficacy of Laparoscopic and Endoscopic Cooperative Surgery Compared to Endoscopic Resection for Duodenal Tumor Treatment. Asian Journal of Endoscopic Surgery, 18(1), e70130. https://doi.org/10.1111/ases.70130
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