Yamamoto Hiroyuki, Yoshimizu Shoichi, Hayami Masaru, Tanaka Kosuke, Tamamushi Makoto, Kido Koyo, Kurihara Wataru, Fukuyama Chika, Horiuchi Yusuke, Yoshio Toshiyuki, Hirasawa Toshiaki, Nunobe Souya
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Digestion. 2025 Aug 13:1-6. doi: 10.1159/000547890.
Duodenal laparoscopic and endoscopic cooperative surgery (D-LECS) is a promising hybrid approach to managing duodenal neoplasia, including superficial non-ampullary duodenal epithelial tumors (SNADETs) and subepithelial lesions (SELs). This approach aims to reduce adverse events (AEs), such as delayed perforation, often associated with endoscopic submucosal dissection (ESD). Combining laparoscopic techniques for duodenal stabilization with precise endoscopic resection, D-LECS may provide safer and more comprehensive treatment. However, few studies have compared the outcomes of D-LECS with those of ESD and full-thickness resection (FTR), and suitable endoscopic resection approaches for D-LECS remain unclear.
We retrospectively reviewed records of 80 patients who underwent D-LECS for duodenal neoplasia at our institution between 2011 and 2024. Fifty-six patients underwent D-LECS with ESD for SNADETs (ESD group), whereas 24 underwent D-LECS with FTR for 16 SELs and 8 SNADETs (FTR group). All patients underwent en bloc resection, showing an overall R0 resection rate of 92.5%.
There was no significant difference in overall incidence of Clavien-Dindo grade II or higher AEs between the ESD and FTR groups. However, the ESD group tended to have fewer cases of delayed gastric emptying and higher inflammatory response (p = 0.087 and p = 0.063, respectively). One patient in the FTR group experienced delayed perforation and 2 patients in the ESD group experienced delayed bleeding. However, these events were not significant.
Both D-LECS with ESD and FTR were effective and safe. D-LECS with ESD may be a more suitable approach for SNADETs, whereas D-LECS with FTR is preferable for SELs.
十二指肠腹腔镜与内镜联合手术（D-LECS）是一种用于治疗十二指肠肿瘤的有前景的混合手术方法，包括浅表非壶腹十二指肠上皮肿瘤（SNADETs）和上皮下病变（SELs）。该方法旨在减少不良事件（AEs），如常与内镜黏膜下剥离术（ESD）相关的延迟穿孔。将十二指肠稳定的腹腔镜技术与精确的内镜切除相结合，D-LECS可能提供更安全、更全面的治疗。然而，很少有研究比较D-LECS与ESD和全层切除术（FTR）的结果，且适合D-LECS的内镜切除方法仍不明确。
我们回顾性分析了2011年至2024年在我院接受D-LECS治疗十二指肠肿瘤的80例患者的记录。56例患者接受D-LECS联合ESD治疗SNADETs（ESD组），而24例患者接受D-LECS联合FTR治疗16例SELs和8例SNADETs（FTR组）。所有患者均接受整块切除，总体R0切除率为92.5%。
ESD组和FTR组Clavien-Dindo II级或更高等级不良事件的总体发生率无显著差异。然而，ESD组的胃排空延迟病例往往较少，炎症反应较高（分别为p = 0.087和p = 0.063）。FTR组有1例患者发生延迟穿孔，ESD组有2例患者发生延迟出血。然而，这些事件并不显著。
D-LECS联合ESD和FTR均有效且安全。D-LECS联合ESD可能是治疗SNADETs更合适的方法，而D-LECS联合FTR更适合SELs。
