The incidence and prognosis of true duodenal carcinomas

Buchbjerg, Thomas; Fristrup, Claus Wilki; Mortensen, Michael Bau

doi:10.1016/j.suronc.2015.04.004

Cited by 44 publications

(36 citation statements)

References 26 publications

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“…T HE INCIDENCE RATE concerning duodenal epithelial tumors has previously been reported to be extremely low compared to other gastrointestinal tract cancers. [1][2][3][4] Recently, endoscopic treatments have been performed increasingly frequently for superficial non-ampullary duodenal epithelial tumors (SNADETs) because of recent endoscopic advances. 5,6 However, endoscopic treatments for duodenal tumors remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of endoscopic submucosal dissection using a scissors‐type knife with prophylactic over‐the‐scope clip closure for superficial non‐ampullary duodenal epithelial tumors

Dohi¹,

Yoshida²,

Naito³

et al. 2020

Digestive Endoscopy

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Background and study aim This study aimed to assess the safety and feasibility of endoscopic submucosal dissection (ESD) using a scissors‐type knife with prophylactic closure using over‐the‐scope clip (OTSC) for superficial non‐ampullary duodenal epithelial tumors (SNADETs). Patients and methods Consecutive patients who underwent ESD for SNADETs >10 mm between January 2009 and July 2019 were retrospectively enrolled. We performed ESD using either a needle‐type knife (Flush Knife‐ESD) or a scissors‐type knife (Clutch Cutter‐ESD). Mucosal defects were prophylactically closed using three methods: conventional clip, laparoscopic closure, or OTSC. Results A total of 84 lesions were resected using the Flush Knife‐ESD and the Clutch Cutter‐ESD (37 and 47 patients, respectively), and conventional clip, laparoscopic closure, and OTSC for mucosal defect closure after ESD were applied in 13, 13, and 56 lesions, respectively. The R0 resection rate was significantly higher in the Clutch Cutter‐ESD than that in the Flush Knife‐ESD (97.9% vs 83.8%, respectively, P = 0.040). The intraoperative perforation rate was significantly lower in the Clutch Cutter‐ESD than in the Flush Knife‐ESD (0% vs 13.5%, respectively, P = 0.014). Complete closure rates of conventional clip, laparoscopic closure, and OTSC were 76.9%, 92.3%, and 98.2%, respectively (P = 0.021); and delayed perforation rates were 15.4%, 7.7%, and 1.8%, respectively (P = 0.092). Conclusions Endoscopic submucosal dissection using a scissors‐type knife with prophylactic OTSC closure is safe and feasible for the low‐invasive treatment of SNADETs.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of endoscopic submucosal dissection using a scissors‐type knife with prophylactic over‐the‐scope clip closure for superficial non‐ampullary duodenal epithelial tumors

Dohi¹,

Yoshida²,

Naito³

et al. 2020

Digestive Endoscopy

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“…Although the incidence of early duodenal tumors is rare[15,16], the recent widespread use of endoscopy in regular medical check-ups may increase the detection rates in near future. Previously, aggressive surgical procedures, such as pancreatoduodenectomy or segmental duodenectomy with regional lymph node dissection, were indicated for duodenal tumors regardless of their stage[1,2].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors

Ichikawa¹,

Komatsu²,

Dohi³

et al. 2016

WJG

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AIMTo assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors.METHODSTwelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique.RESULTSTwo SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient.CONCLUSIONLECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.

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“…However, some data are contradictory: similar survival for patients with distal cholangiocarcinoma and PDAC was recently reported[89], as well as comparable prognosis for ampullary and extra-ampullary duodenal carcinomas[90]. Even ampullary carcinoma with the same median postoperative survival as PDAC has been described from Denmark[91]. Routine histopathology from 207 PD specimens were recently re-evaluated by two independent experienced pancreatic pathologists, and 53% of distal cholangiocarcinoma were misdiagnosed as PDAC[92].…”

Section: Distal Cholangiocarcinoma Ampullary and Duodenal Adenocarcimentioning

confidence: 99%

Updated therapeutic outcome for patients with periampullary and pancreatic cancer related to recent translational research

Buanes¹

2016

WJG

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Chemotherapy with improved effect in patients with metastatic pancreatic cancer has recently been established, launching a new era for patients with this very aggressive disease. FOLFIRINOX and gemcitabine plus nab-paclitaxel are different regimens, both capable of stabilizing the disease, thus increasing the number of patients who can reach second line and even third line of treatment. Concurrently, new windows of opportunity open for nutritional support and other therapeutic interventions, improving quality of life. Also pancreatic surgery has changed significantly during the latest years. Extended operations, including vascular/multivisceral resections are frequently performed in specialized centers, pushing borders of resectability. Potentially curative treatment including neoadjuvant and adjuvant chemotherapy is offered new patient groups. Translational research is the basis for the essential understanding of the ongoing development. Even thou biomarkers for clinical management of patients with periampullary tumors have almost been lacking, biomarker driven trials are now in progress. New insight is constantly made available for clinicians; one recent example is selection of patients for gemcitabine treatment based on the expression level of the human equilibrium nucleoside transporter 1. An example of new diagnostic tools is identification of early pancreatic cancer patients by a three-biomarker panel in urine: The proteins lymphatic vessel endothelial hyaluronan receptor 1, regenerating gene 1 alpha and translation elongation factor 1 alpha. Requirement of treatment guideline revisions is intensifying, as combined chemotherapy regimens result in unexpected advantages. The European Study Group for Pancreatic Cancer 4 trial outcome is an illustration: Addition of capecitabine in the adjuvant setting improved overall survival more than expected from the effect in advanced disease. Rapid implementation of new treatment options is mandatory when progress finally extends to patients with this serious disease.

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The incidence and prognosis of true duodenal carcinomas

Cited by 44 publications

References 26 publications

Efficacy and safety of endoscopic submucosal dissection using a scissors‐type knife with prophylactic over‐the‐scope clip closure for superficial non‐ampullary duodenal epithelial tumors

Efficacy and safety of endoscopic submucosal dissection using a scissors‐type knife with prophylactic over‐the‐scope clip closure for superficial non‐ampullary duodenal epithelial tumors

Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors

Updated therapeutic outcome for patients with periampullary and pancreatic cancer related to recent translational research

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