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Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms

BACKGROUND: Local duodenectomy and primary closure is a simple option for some nonampullary duodenal neoplasms. Minimizing the resection area while ensuring curability is necessary for safe primary duodenal closure. However, it is often difficult to determine the appropriate resection line from the...

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Autores principales: Miwa, Takeshi, Yamada, Suguru, Shibuya, Kazuto, Hirano, Katsuhisa, Takami, Hideki, Watanabe, Toru, Hayashi, Masamichi, Yoshioka, Isaku, Kodera, Yasuhiro, Fujii, Tsutomu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9422168/
https://www.ncbi.nlm.nih.gov/pubmed/36038851
http://dx.doi.org/10.1186/s12893-022-01771-0
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author Miwa, Takeshi
Yamada, Suguru
Shibuya, Kazuto
Hirano, Katsuhisa
Takami, Hideki
Watanabe, Toru
Hayashi, Masamichi
Yoshioka, Isaku
Kodera, Yasuhiro
Fujii, Tsutomu
author_facet Miwa, Takeshi
Yamada, Suguru
Shibuya, Kazuto
Hirano, Katsuhisa
Takami, Hideki
Watanabe, Toru
Hayashi, Masamichi
Yoshioka, Isaku
Kodera, Yasuhiro
Fujii, Tsutomu
author_sort Miwa, Takeshi
collection PubMed
description BACKGROUND: Local duodenectomy and primary closure is a simple option for some nonampullary duodenal neoplasms. Minimizing the resection area while ensuring curability is necessary for safe primary duodenal closure. However, it is often difficult to determine the appropriate resection line from the serosal side. We developed clip-guided local duodenectomy to easily determine the resection range and perform local duodenectomy safely, then performed a retrospective observational study to confirm the safety of clip-guided local duodenectomy. METHODS: The procedure is as follows: placing endoscopic metal clips at four points on the margin around the tumor within 3 days before surgery, identifying the tumor extent with the clips under X-ray imaging during surgery, making an incision to the duodenum just outside of the clips visualized by X-ray imaging, full-thickness resection of the duodenum with the clips as guides of tumor demarcation, and transversely closure by Gambee suture. We evaluated clinicopathological data and surgical outcomes of patients who underwent clip-guided local duodenectomy at two surgical centers between January 2010 and May 2020. RESULTS: Eighteen patients were included. The pathological diagnosis was adenoma (11 cases), adenocarcinoma (6 cases), and GIST (1 case). The mean ± SD tumor size was 18 ± 6 mm, and the tumor was mainly located in the second portion of the duodenum (66%). In all cases, the duodenal defect was closed with primary sutures. The mean operation time and blood loss were 191 min and 79 mL, respectively. The morbidity was 22%, and all complications were Clavien–Dindo grade II. No anastomotic leakage or stenosis was observed. In the 6 adenocarcinoma patients, all were diagnosed with pT1a, and postoperative recurrence was not observed. The 1-year overall and recurrence free survival rate was 100%. CONCLUSIONS: Clip-guided local duodenectomy is a safe and useful surgical option for minimally local resection of nonampullary duodenal neoplasms such as duodenal adenoma, GIST, and early adenocarcinoma.
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spelling pubmed-94221682022-08-30 Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms Miwa, Takeshi Yamada, Suguru Shibuya, Kazuto Hirano, Katsuhisa Takami, Hideki Watanabe, Toru Hayashi, Masamichi Yoshioka, Isaku Kodera, Yasuhiro Fujii, Tsutomu BMC Surg Research Article BACKGROUND: Local duodenectomy and primary closure is a simple option for some nonampullary duodenal neoplasms. Minimizing the resection area while ensuring curability is necessary for safe primary duodenal closure. However, it is often difficult to determine the appropriate resection line from the serosal side. We developed clip-guided local duodenectomy to easily determine the resection range and perform local duodenectomy safely, then performed a retrospective observational study to confirm the safety of clip-guided local duodenectomy. METHODS: The procedure is as follows: placing endoscopic metal clips at four points on the margin around the tumor within 3 days before surgery, identifying the tumor extent with the clips under X-ray imaging during surgery, making an incision to the duodenum just outside of the clips visualized by X-ray imaging, full-thickness resection of the duodenum with the clips as guides of tumor demarcation, and transversely closure by Gambee suture. We evaluated clinicopathological data and surgical outcomes of patients who underwent clip-guided local duodenectomy at two surgical centers between January 2010 and May 2020. RESULTS: Eighteen patients were included. The pathological diagnosis was adenoma (11 cases), adenocarcinoma (6 cases), and GIST (1 case). The mean ± SD tumor size was 18 ± 6 mm, and the tumor was mainly located in the second portion of the duodenum (66%). In all cases, the duodenal defect was closed with primary sutures. The mean operation time and blood loss were 191 min and 79 mL, respectively. The morbidity was 22%, and all complications were Clavien–Dindo grade II. No anastomotic leakage or stenosis was observed. In the 6 adenocarcinoma patients, all were diagnosed with pT1a, and postoperative recurrence was not observed. The 1-year overall and recurrence free survival rate was 100%. CONCLUSIONS: Clip-guided local duodenectomy is a safe and useful surgical option for minimally local resection of nonampullary duodenal neoplasms such as duodenal adenoma, GIST, and early adenocarcinoma. BioMed Central 2022-08-29 /pmc/articles/PMC9422168/ /pubmed/36038851 http://dx.doi.org/10.1186/s12893-022-01771-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Miwa, Takeshi
Yamada, Suguru
Shibuya, Kazuto
Hirano, Katsuhisa
Takami, Hideki
Watanabe, Toru
Hayashi, Masamichi
Yoshioka, Isaku
Kodera, Yasuhiro
Fujii, Tsutomu
Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms
title Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms
title_full Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms
title_fullStr Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms
title_full_unstemmed Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms
title_short Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms
title_sort clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9422168/
https://www.ncbi.nlm.nih.gov/pubmed/36038851
http://dx.doi.org/10.1186/s12893-022-01771-0
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