Iwao Kitazono, PhD1, Kentaro Gejima1, Hizuru Kumemura1, Akira Hiwatashi1, Yuichiro Nasu2, Fumisato Sasaki2, Akio Ido2, Yutaka Imoto1. 1Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Science, 2Digestive and Lifestyle Disease, Kagoshima University Graduate School of Medical and Dental Scinece
Introduction: In locally-treatable gastrointestinal tumors, laparoscopic endoscopic cooperative surgery (LECS) is a minimally-invasive technique that can avoid excessive resection of the gastrointestinal tract.
Objective: To share our therapeutic guidelines and surgical technique of LECS for gastroduodenal tumors.
Subjects: Nineteen patients who underwent LECS for gastroduodenal tumors (10 patients with gastric tumor and 9 patients with duodenal tumor). [Results]1)Gastric tumors (9 GIST, 1 glomus):1.Site of lesion was U (4 patients), M (3), or L (2), 2.Operative procedure was acquired in a stepwise manner from classical LECS (4 patients) to inverted LECS (2) to non-exposed endoscopic wall-inversion surgery: NEWS(4). 3.Operative outcome revealed no postoperative complications. 2) Duodenal tumors (6 adenoma, 2 M cancer, 1 ectopic pancreas):1.Site of lesion was bulbus duodeni (1 patient), superior part (2), or descending part (6); 2.Operative procedure was ESD followed by laparoscopic continuous suture in a single seromuscular layer for patients with preoperatively confirmed or suspected cancer, or full-thickness resection followed by Albert-Lembert suture along the short axis for patients unable to undergo ESD. In all cases, C-tube was placed to prevent bleeding and perforation at the site of resection due to exposure to bile; 3.Operative outcome included successful endoscopic hemostasis upon bleeding from exposed vessel on postoperative day 4 in 1 patient and anastomotic leak in 1 patient. The event of anastomotic leak resolved after 14 days of bile drainage through C-tube and conservative therapy. Compared with 26 patients who underwent ESD alone, those who underwent LECS had significantly larger diameters of resected specimens and tumors (p < 0.05) but no significant difference in the incidence of postoperative bleeding and delayed perforation.
Conclusion: For gastroduodenal tumors, LECS is a minimally-invasive and safe therapeutic option as it combines advantages of both laparoscopy and endoscopy. In particular, C-tube placement for bile drainage was effective in reducing exposure of the suture site to bile as well as supporting drainage after anastomotic leak.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86100
Program Number: P682
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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