Department of Pancreatic and Gastric Surgical Oncology.
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Surg. 2023 Jul 1;109(7):1835-1841. doi: 10.1097/JS9.0000000000000440.
Duodenal neuroendocrine tumors (D-NETs) are uncommon. The surgical treatment for D-NETs was in debate. Laparoscopic and endoscopic cooperative surgery (LECS) is a promising approach for treating gastrointestinal tumors. The study aimed to evaluate the feasibility and safety of LECS for D-NETs. Meanwhile, the authors described the details of the LECS technique.
All patients diagnosed with D-NETs underwent LECS between September 2018 and April 2022 were retrospectively reviewed. The endoscopic procedures were performed with endoscopic full-thickness resection. The defect was manually closed under the surveillance of the laparoscopy.
A total of seven patients were enrolled, including three men and four women. The median age was 58 years (ranging from 39-65). Four tumors were located in the bulb and three in the second portion. All cases were diagnosed as NET with grade G1. The tumor depth was pT1 in two cases and pT2 in five cases. The median specimen size and the tumor size were 22 mm (ranging from 10-30) and 8.0 mm (ranging from 2.3-13.0), respectively. En-bloc resection and curative resection rates are 100 and 85.7%, respectively. There were no severe complications. Until 1 June 2022, there was no recurrence. The median follow-up was 9.5 months (range, 1.4-45.1).
LECS with endoscopic full-thickness resection is a reliable surgical procedure. The minimally invasive advantages of LECS enable more individualized treatment options for a specific group. Limited by the length of observation, the long-term performance of LECS for D-NETs requires additional investigation.
十二指肠神经内分泌肿瘤（D-NETs）较为少见。D-NETs 的手术治疗存在争议。腹腔镜与内镜联合手术（LECS）是一种治疗胃肠道肿瘤的有前途的方法。本研究旨在评估 LECS 治疗 D-NETs 的可行性和安全性。同时，作者描述了 LECS 技术的细节。
回顾性分析 2018 年 9 月至 2022 年 4 月期间接受 LECS 治疗的所有 D-NETs 患者。内镜手术采用内镜全层切除术进行。在腹腔镜监测下手动闭合缺损。
共纳入 7 例患者，其中男 3 例，女 4 例。中位年龄为 58 岁（39-65 岁）。4 例肿瘤位于十二指肠球部，3 例位于十二指肠第二段。所有病例均诊断为 NET G1 级。肿瘤深度 2 例为 pT1，5 例为 pT2。标本大小和肿瘤大小的中位数分别为 22mm（10-30mm）和 8.0mm（2.3-13.0mm）。整块切除率和根治性切除率分别为 100%和 85.7%。无严重并发症。截至 2022 年 6 月 1 日，无复发。中位随访时间为 9.5 个月（1.4-45.1 个月）。
内镜全层切除术联合 LECS 是一种可靠的手术方法。LECS 的微创优势为特定患者群体提供了更多的个体化治疗选择。受观察时间限制，LECS 治疗 D-NETs 的长期疗效还需要进一步研究。
