| Theme |
Advancement in Diagnosis and Treatment for Duodenal Neoplasms |
| Title |
Surgical Limited Resection for Patients with Superficial Nonampullary Duodenal Tumor |
| Author |
Nobutsugu Abe |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Yoshikazu Hashimoto |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Atsuko Ohki |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Hirohisa Takeuchi |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Gen Nagao |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Yutaka Suzuki |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Tadahiko Masaki |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Toshiyuki Mori |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Masanori Sugiyama |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Hideaki Mizuno |
Department of Surgery, Mejiro Second General Hospital |
| Author |
Shin-ichi Horiai |
Department of Surgery, Mejiro Second General Hospital |
| [ Summary ] |
Herein the surgical management for superficial nonampullary duodenal tumors (SNADT) is discussed. We also present our experiences with the so-called limited resections such as transduodenal excision and local full-thickness resection for SNADT. Surgical resection is the treatment of choice for SNADT not amenable to endoscopic resection in terms of technical and/or oncological reasons. Mucosal carcinoma, as well as adenoma, benign nonepithelial tumors, and GIST, rarely metastasizes to lymph nodes; therefore, even when surgery is indicated, minimal local resection that is as small as possible without lymphadenectomy, such as transduodenal excision or local full- thickness resection, should be undertaken as an alternative to endoscopic resection. There is no consensus regarding the laparoscopic resection of epithelial tumors (adenomas and carcinomas) by opening the intestine under the aeroperitoneum, because the problem of peritoneal or port site seeding remains unsolved. Thus, when epithelial SNADT (adenomas and carcinomas) removal by transduodenal excision or local full-thickness resection in a laparoscopic fashion is planned, a laparoscopy-assisted procedure (the pancreatoduodenum is mobilized laparoscopically followed by extracorporeal tumor excision and reconstruction) may be reasonable. In contrast, any type of laparoscopic procedure including laparoscopic endoscopic cooperative surgery can be applied to non-epithelial or submucosal SNADT. Submucosal adenocarcinoma and neuroendocrine tumor (carcinoid tumor) carry a significant risk of nodal metastasis ; therefore, it should be treated by surgery simultaneously with lymphadenectomy, namely, pancreatoduodenectomy or segmental duodenectomy. However, a neuroendocrine tumor, measuring < 10 mm with no nodal metastasis on intraoperative pathological examination may be treated by limited resection. |