Early Duodenal Cancer Research Articles

Pancreas-sparing partial duodenectomy as an alternative to emergency pancreaticoduodenectomy for a major duodenal perforation: a case report.

A 71-year-old woman underwent endoscopic submucosal dissection for early duodenal cancer at the second portion of the duodenum and developed acute peritonitis due to delayed duodenal perforation. Emergency laparotomy was performed. A huge perforation formed at the descending duodenum without ampulla involvement. Pancreas-sparing partial duodenectomy (PPD) with gastrojejunostomy was performed (250min operative time) with 50mL of intraoperative blood loss. She required intensive care for 3days and was discharged on postoperative day 21 with no severe complications. Emergency treatment for a major duodenal injury or perforation remains challenging because of high morbidity and mortality. An appropriate treatment should be considered according to the nature of the defect. Although PPD is an acceptable procedure for patients with a duodenal neoplasm, its use in emergency surgery is rarely reported. PPD is more reliable than primary repair or anastomosis using a jejunal wall, and less invasive than pancreaticoduodenectomy, for emergency treatment. We performed PPD in this patient because the duodenal perforation was too large to reconstruct and did not involve the ampulla. PPD can be a safe and feasible alternative surgical procedure to pancreaticoduodenectomy for a major duodenal perforation, especially in patients with a duodenal perforation that does not involve the ampulla.

Comprehensive proteogenomic characterization of early duodenal cancer reveals the carcinogenesis tracks of different subtypes

The subtypes of duodenal cancer (DC) are complicated and the carcinogenesis process is not well characterized. We present comprehensive characterization of 438 samples from 156 DC patients, covering 2 major and 5 rare subtypes. Proteogenomics reveals LYN amplification at the chromosome 8q gain functioned in the transmit from intraepithelial neoplasia phase to infiltration tumor phase via MAPK signaling, and illustrates the DST mutation improves mTOR signaling in the duodenal adenocarcinoma stage. Proteome-based analysis elucidates stage-specific molecular characterizations and carcinogenesis tracks, and defines the cancer-driving waves of the adenocarcinoma and Brunner’s gland subtypes. The drug-targetable alanyl-tRNA synthetase (AARS1) in the high tumor mutation burden/immune infiltration is significantly enhanced in DC progression, and catalyzes the lysine-alanylation of poly-ADP-ribose polymerases (PARP1), which decreases the apoptosis of cancer cells, eventually promoting cell proliferation and tumorigenesis. We assess the proteogenomic landscape of early DC, and provide insights into the molecular features corresponding therapeutic targets.

Early duodenal cancer successfully treated by endoscopic submucosal dissection with an ultra-thin endoscope in spite of severe esophageal stricture.

Early duodenal cancer successfully treated by endoscopic submucosal dissection with an ultra-thin endoscope in spite of severe esophageal stricture.

Endoscopic excision as a viable alternative to major resection for early duodenal cancers: A population-based cohort study

BackgroundDuodenal cancer presents an elusive therapeutic challenge for clinicians to treat because of its highly malignant behavior and anatomical complexity. Endoscopic excision has been administered to treat early-stage cancers of upper gastrointestinal tract, especially esophagus and stomach cancer. There is currently a scarcity of data regarding the application and efficacy of endoscopic resection for early duodenal cancer due to its rarity. This study aimed at exploring the prevalence and efficacy of endoscopic excision in treatment for early duodenal cancer in comparison with major surgery. MethodsThis cohort study retrospectively collected patients with primary Tis/T1-N0-M0 duodenal cancer in the Surveillance, Epidemiology, and End Results database from 2004 to 2017. Prevalence of endoscopic excision in duodenal cancer treatment, overall survival (OS) and disease-specific survival (DSS) of patients who received different tumor-resection procedures were estimated. ResultsA total of 1354 patients with Tis/T1-stage duodenal cancer were identified. Most patients (69.4%) underwent tumor resection as initial treatments. Among them, 65.7% underwent endoscopic excision, while 34.3% underwent major surgery. The multivariable Cox analyses revealed that endoscopic excision was associated with a significantly favorable OS (HR: 0.70; 95% CI: 0.52–0.95, p = 0.02) and DSS (HR: 0.32; 95% CI: 0.17–0.60, p < 0.001), compared to major surgery, for Tis/T1-stage cancer patients. In addition to cancer-related deaths (p < 0.001), endoscopic resection manifested significantly lower cumulative mortality rate of post-operative infectious diseases (p = 0.03). ConclusionEndoscopic resection currently accounted for approximately two-thirds of all procedures to resect Tis/T1-stage duodenal tumor. Endoscopic resection represents a viable therapeutic option in the management of Tis/T1-stage duodenal cancer for its oncological superiorities to major surgery and its capacity to reduce operative traumas and morbidities.

Endoscopic Full-Thickness Resection in a Patient With Early Duodenal Cancer.

Endoscopic Full-Thickness Resection in a Patient With Early Duodenal Cancer.

Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD

Background: Duodenal ESD is considered especially difficult with perforation and bleeding. This study assessed safer duodenal ESD procedures, especially with regard to obtaining a good operation view using a ring-thread method and closure of a post-ESD artificial ulcer.Methods: From 2013 to 2015, 17 patients who were diagnosed with duodenal adenoma or early duodenal cancer >20 mm in diameter underwent conventional ESD (C group). From 2016 to 2017, 12 patients underwent ring-shaped thread counter traction ESD with hemoclips and/or Over-The-Scope Clip (OTSC) (Ovesco Endoscopy GmbH, Tuebingen, Germany) closure of post ESD artificial ulcer (ring group). An observational study between the C group and Ring group was conducted. The primary outcome was perforation events during ESD (UMIN000026184).Results: There was a significant difference in perforation during ESD with five cases vs. 0 case in C and ring groups (p = .038). For bleeding that needed to be coagulated by forceps during ESD, there was a significant difference with four cases in the C group (p = .07). The total procedure time was 96.6 ± 28.2 and 72.8 ± 24.2 (min) with a significant difference (p = .027).Conclusions: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.

Acute obstructive pancreatitis after pancreas-sparing total duodenectomy in a patient with pancreas divisum: a case report.

BackgroundPancreas-sparing total duodenectomy (PSTD) is an ideal recommended procedure for patients with multiple duodenal adenomas or early duodenal cancer. We herein report a rare but serious complication of PSTD.Case presentationA 20-year-old woman with duodenal adenocarcinoma underwent PSTD. On postoperative day one, she complained of severe abdominal pains. Her serum amylase and serum pancreatic amylase levels were extremely elevated (Amy, 1296 IU/L; P-Amy, 1273 IU/L). With contrast enhanced CT, acute obstructive pancreatitis with pancreas divisum due to the ligation of the dorsal pancreatic duct was highly suspected. An emergency operation was performed to relieve the pancreatic duct obstruction, and an additional anastomosis between the dorsal pancreatic duct and jejunum was performed. The patient’s postoperative course was mostly uneventful, and her discomfort improved immediately.ConclusionWhen we perform pancreas-sparing total duodenectomy, some form of pancreatography is necessary to exclude pancreas divisum.

Abstract A37: MSI is not an important feature in early onset pancreatic carcinoma

Abstract Background and Aim: There is scant information on pancreatic cancer occurring at young age. About 5 to 10 percent of patients with pancreatic cancer have a family history of pancreatic cancer, which is partially due to defined hereditary syndromes like Lynch syndrome. Recently, we have identified deletions of the 3’ end of the EPCAM gene as a novel cause of this hereditary syndrome. In the cohort of patients with EPCAM deletions a relatively high number of pancreatic cancers and duodenal cancers were observed. We therefore aimed to assess whether development of pancreatic or duodenal cancer at young age might be an indication of EPCAM-associated Lynch syndrome. Methods: We searched the Dutch Pathology Registry (PALGA) to identify all patients who were diagnosed with pancreatic carcinoma (PC), ampulla of Vater carcinoma (VC) or duodenal carcinoma (DC) before the age of 50 in The Netherlands between January 2000 and December 2012. Immunohistochemical analysis was used to analyze mismatch repair (MMR)- and EPCAM-protein expression. MS-status was determined by a panel of 5 mononucleotide repeats in cases with an aberrant MMR protein pattern. Furthermore, multiplex ligation-dependent probe amplification will be performed in case of an absent EPCAM staining or loss of MSH2 and MSH6 protein expression. Results: An aberrant MMR-IHC for PMS2 combined with microsatellite instability (MSI) was identified in 1 of 48 (2%) PC diagnosed before age 50. In 24 VC patients, one tumor (4%) showed MSI with absence of both MLH1 and PMS2 staining. This patient had a history of colon carcinoma at the age of 43 years. All patients showed a normal immunohistochemical staining for MSH2 and MSH6. EPCAM protein expression was present in all cases, except one case with an anaplastic pancreas carcinoma where EPCAM was absent in the vimentine-positive area of the tumor. Eight out of 22 DC tumors (36%) showed a MMR-defective phenotype with MSI, of which 2 with an aberrant MSH2 and MSH6 staining and a positive EPCAM protein expression. One of these two patients had a history of colon carcinoma at the age of 24 and 26 years. Conclusion: This nationwide study cohort suggests that early onset pancreatic cancer and ampulla of Vater cancer are at most rarely associated with (EPCAM-associated) Lynch syndrome, in contrast to early onset duodenal cancer. Citation Format: Monica AJ Van Zanten, Marlies JE Kempers, Marjolijn JL Ligtenberg, Iris D. Nagtegaal. MSI is not an important feature in early onset pancreatic carcinoma. [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Innovations in Research and Treatment; May 18-21, 2014; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2015;75(13 Suppl):Abstract nr A37.

PTH-142 Laparoscopic assisted surgery (Intraluminal Surgery): gastroduodenal lesions resecction and laparoscopic monitored colonoscopic polypectomy (LMCP). texas endosurgery institute experience

Introduction Intraluminal surgery began with the advent of endoscopy. Laparoscopic assisted intraluminal technique is a novel alternative to open or laparoscopic surgery. Endoscopic lesions resection is limited for the view of endoscopic, insufficient number of instrument channels, and the inability to obtain adequate margins without risking perforation. The aim of this study is to demonstrate the feasibility and safety of the use of a hybrid technique. Method From May 1990 to February 2015, all patients undergoing LMCP and early gastric and duodenal lesions were analysed and prospectively followed with control endoscopy studies, 6 months, 1 year and every year there after. Operations were performed laparoscopically in conjunction with endoscopy. Results 24 patients were undergoing to gastro-duodenal lesions resection. 10 early gastric cancer (Stage I), 6 wedge of carcinoid tumour, 4 duodenal adenocarcinoma and 4 malignant polyps at the gastro-oesophageal junction. 320 colonic polyps were removed in 270 patients. 229 polyps were adenomas (114 tubular-villus, 58 villus, and 57 tubular), 66 were carcinomas (40 mod diff, 26 highly diff), 25 with other histologic type. Conclusion Long-term follow-up demonstrated that intraluminal surgery for early gastric and duodenal cancer is a feasible and safe alternative. Malignant lesions identified during LMCP can be treated laparoscopically during the same operation. Disclosure of interest None Declared.

Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status.

To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors. A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach. The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described. Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.

Endoscope ultrasonography with micro-probe in diagnosis duodenal lesions

Objective To evaluate the diagnosis and application values of endoscopic uhrasonography （EUS） with micro-probe in duodenal lesions. Methods Clinical data of 37 patients with duodenal lesions and underwent EUS with micro-probe were analyzed retrospectively. All lesions were treated with endoscopic mucosal resection or surgical resection to get the pathological diagnosis. The diagnostic accuracy of EUS with microprobe and endoscopic biopsy was analyzed respectively. Results The overall diagnosis accuracy of EUS with micro-probe on duodenal lesions was 78.38% （29/37）, with a higher diagnostic rate in duodenal lipoma 4/4 and duodenal adenomas 10/12 than in early duodenal cancer 2/4 or inflammatory hyperplasia 3/8. The overall diagnostic accuracy of biopsy on duodenal lesions was 40. 54% （ 15/37）, with a higher diagnosis rate on duodenal carcinoid 1/1 and adenoma 7/12 than on duodenal stromal tumor 1/10 and lipema 1/4. Conclusion Pathological evaluation of endoscopic biopsy sample is not a golden standard for the diagnosis of duodenal lesions, while EUS with micro-probe has better diagnostic and application value. Key words: Endoscopic ultrasonography; Duodenum; Micro-probe ; Diagnose accordance rate

A case of early duodenal cancer observed during follow-up of intraductal papillary mucinous neoplasm

Duodenal cancer is a rare disease that accounts for 0.3％ of all primary gastrointestinal tract cancers. We report the case of an elderly patient diagnosed with and treated for early duodenal cancer detected during follow-up after resection of intraductal papillary mucinous neoplasm (IPMN). An 82-year-old man was diagnosed with IPMN during hospitalization for acute pancreatitis in 2004 and underwent pancreatic resection. In 2008, an elevated lesion measuring 15 mm in size was detected at the anterior wall of the duodenal bulb during gastroscopy. A mucosal lesion was also noted during endoscopic ultrasonography. Histopathological examination of a biopsy specimen identified well-differentiated adenocarcinoma. On the basis of these findings, endoscopic mucosal resection was performed. Although the tumor was resected in two parts, no residual malignancy was noted. Histopathological examination of the resected specimen revealed a 20×18 mm well-differentiated adenocarcinoma, pT1a (m), med, INF-α, ly (-), v (-), pHMx, pVM0. Gastrointestinal endoscopy performed two months after surgery and in 2013 did not show any obvious signs of tumor recurrence. IPMN is sometimes reported to occur in combination with cancers of other organs. However, to our knowledge this is the first case report of early duodenal cancer occurring in a patient with IPMN.

A case of early duodenal cancer detected at screening upper gastrointestinal endoscopy

A case of early duodenal cancer detected at screening upper gastrointestinal endoscopy

A case of early duodenal cancer complicated with hypopharyngeal cancer

A case of early duodenal cancer complicated with hypopharyngeal cancer

A case of early duodenal cancer detected by gastroduodenoscopy

A case of early duodenal cancer detected by gastroduodenoscopy

A case of early duodenal cancer accompanied by early gastric cancer successfully diagnosed by magnifying endoscopy

A case of early duodenal cancer accompanied by early gastric cancer successfully diagnosed by magnifying endoscopy

Ability of FDG-PET to detect all cancers in patients with familial adenomatous polyposis, and impact on clinical management

Familial adenomatous polyposis (FAP) is characterised by colonic and duodenal adenomatous polyps that carry a risk of malignant transformation. Malignant degeneration of duodenal adenomas is difficult to detect. We speculated that 2-((18)F)-fluoro-2-deoxy-D: -glucose positron emission tomography (FDG-PET) might be able to detect early duodenal cancer in FAP. Accordingly, we investigated the role of FDG-PET in the management of FAP patients. FDG-PET was performed in 24 FAP patients. Eight had advanced duodenal adenomas (Spigelman IV), including two patients with duodenal cancer. Scans were defined as positive on the basis of focal FDG accumulation. Pathological FDG accumulation was absent in 19 of 24 patients. All six patients with Spigelman IV duodenal adenomas (without cancer) were negative; two of these underwent a duodenectomy and pathological examination did not reveal duodenal cancer. In five patients, FDG-PET revealed significant uptake, in the duodenum (2), lower abdomen (1), lung (1) and multiple sites in the abdomen (1). These hot spots correlated with duodenal cancer (2), abdominal metastasis (1) and sclerosing haemangioma of the lung (1). We failed to make a histopathological diagnosis in the single patient with multiple intra-abdominal sites of FDG uptake. None of the patients from the FDG-PET-negative group developed cancer during follow-up (mean 2.8 years). FDG-PET detected all the cancers present, and none of the patients with negative FDG-PET developed cancer. This suggests that positive FDG-PET in FAP patients should lead to further examinations to rule out cancer. In patients with negative FDG-PET a more conservative approach seems justified.

Early duodenal cancer resected by endoscopic mucosal resection, Report of a case

Early duodenal cancer resected by endoscopic mucosal resection, Report of a case

Two Cases of Early Duodenal Cancer Treated Endoscopically

Two Cases of Early Duodenal Cancer Treated Endoscopically

A case of early duodenal cancer at the opposite side of the papilla Vater, resected by endoscopic mucosal resection

A case of early duodenal cancer at the opposite side of the papilla Vater, resected by endoscopic mucosal resection