| Theme |
New Developments in Laparoscopy and Endoscopy Cooperative Surgery (LECS) |
| Title |
Concept and Indication of Local Resection of Duodenal Tumors |
| Author |
Nobutsugu Abe |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Youhei Kojima |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Yoshikazu Hashimoto |
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 |
| [ Summary ] |
The representative methods of surgical local resection of the duodenum include transduodenal excision and local full‒thickness resection. Classical LECS (laparoscopy and endoscopy cooperative surgery) is a new modification of the latter. More recently, a new method of local resection/LECS, that is, ESD (endoscopic submucosal dissection) followed by laparoscopic seromuscular suturing, has also been developed. An optimal selection algorithm for each surgical procedure for duodenal tumors remains controversial because of the complexity of the relevant anatomy, its rarity, and the wide spectrum of pathologies that can be encountered. Mucosal carcinoma, as well as adenoma, benign non‒epithelial tumors, and GIST (gastrointestinal stromal tumor), rarely metastasizes to lymph nodes. Therefore, even when surgery is indicated, local resection that is as small as possible without lymphadenectomy such as transduodenal excision or local full‒thickness resection, including LECS, should be undertaken as an alternative to pancreatoduodenectomy. LECS enables en bloc and full‒thickness resection with a minimally sufficient surgical margin, both vertically and laterally, in the narrow lumen of the duodenum, although future studies are required to evaluate the indication, reliability, safety, and long‒term outcomes. |