Surgical oncology · 2026
Short-term outcomes of a refined duodenal LECS technique: A single-center retrospective series.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Harada Hiroki, Sakuraya Mikiko, Wada Takuya, Kitahara Gen, Minoura Hiroyuki, Matsumura Risa, Manaka Keisuke, Okuno Kota, Fujita Shohei, Higuchi Tadashi, Tajima Hiroshi, Kumagai Koshi, Naitoh Takeshi, Kumamoto Yusuke, Yamashita Keishi, Kusano Chika, Hiki Naoki
Аннотация
BACKGROUND: Duodenal laparoscopic and endoscopic cooperative surgery (D-LECS) is an alternative to endoscopic submucosal dissection (ESD) for duodenal tumors, but technical instability and adverse events remain concerns. We aimed to describe the short-term outcomes of refined D-LECS and temporal changes in horizontal margin status and operative time.
METHODS: This retrospective single-center study included 40 patients who underwent D-LECS between August 2021 and February 2026. Refinements included complete Kocher mobilization to straighten the duodenum and stabilize ESD, use of a Clutch Cutter under the water pressure method for safe dissection and hemostasis, duodenal re-fixation to restore physiological orientation, full-thickness horizontal mattress suturing for secure defect closure, and selective use of the reopenable clip-over-the-line method for defects at the pancreatic attachment. The primary endpoint was delayed perforation; secondary endpoints included postoperative outcomes, pathological margin status, R0 resection, and operative time.
RESULTS: En bloc resection was achieved in all cases. Nine patients (22.5%) experienced Clavien-Dindo Grade II complications, and two patients (5.0%) experienced Grade III complications, including one delayed perforation and one wound infection requiring drainage. No patient required reoperation, and DGE occurred in one patient (2.5%). Median postoperative hospital stay was 8 days. HM1/HMX was observed in 5 lesions, while VMX was observed in 1 lesion and no lesion was VM1. The pathological R0 resection rate was 87.5% (35/40). HM1/HMX was observed in 4 of 12 patients (33.3%) in the early phase and 1 of 28 patients (3.6%) in the late phase. Mean operation time decreased from 323 min in the early phase to 270 min in the late phase (p = 0.048).
CONCLUSIONS: Refined D-LECS was associated with acceptable short-term outcomes in this single-center retrospective series. HM1/HMX was less frequent and operation time was shorter in the later phase, although these temporal changes cannot be attributed to individual technical refinements.
METHODS: This retrospective single-center study included 40 patients who underwent D-LECS between August 2021 and February 2026. Refinements included complete Kocher mobilization to straighten the duodenum and stabilize ESD, use of a Clutch Cutter under the water pressure method for safe dissection and hemostasis, duodenal re-fixation to restore physiological orientation, full-thickness horizontal mattress suturing for secure defect closure, and selective use of the reopenable clip-over-the-line method for defects at the pancreatic attachment. The primary endpoint was delayed perforation; secondary endpoints included postoperative outcomes, pathological margin status, R0 resection, and operative time.
RESULTS: En bloc resection was achieved in all cases. Nine patients (22.5%) experienced Clavien-Dindo Grade II complications, and two patients (5.0%) experienced Grade III complications, including one delayed perforation and one wound infection requiring drainage. No patient required reoperation, and DGE occurred in one patient (2.5%). Median postoperative hospital stay was 8 days. HM1/HMX was observed in 5 lesions, while VMX was observed in 1 lesion and no lesion was VM1. The pathological R0 resection rate was 87.5% (35/40). HM1/HMX was observed in 4 of 12 patients (33.3%) in the early phase and 1 of 28 patients (3.6%) in the late phase. Mean operation time decreased from 323 min in the early phase to 270 min in the late phase (p = 0.048).
CONCLUSIONS: Refined D-LECS was associated with acceptable short-term outcomes in this single-center retrospective series. HM1/HMX was less frequent and operation time was shorter in the later phase, although these temporal changes cannot be attributed to individual technical refinements.