Safety and efficacy of surgical and endoscopic resection in the treatment of duodenal subepithelial lesions

Chen Li; Chengbai Liang; Xuehong Wang; Meixian Le; Deliang Liu; Yuyong Tan

doi:10.1007/s00464-021-08740-3

Safety and efficacy of surgical and endoscopic resection in the treatment of duodenal subepithelial lesions

Surg Endosc. 2022 Jun;36(6):4145-4153. doi: 10.1007/s00464-021-08740-3. Epub 2021 Sep 22.

Authors

Chen Li^{1

2

3

4}, Chengbai Liang^{1

2}, Xuehong Wang^{1

2}, Meixian Le^{1

2}, Deliang Liu^{5

6}, Yuyong Tan^{7

8}

Affiliations

¹ Department of Gastroenterology, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, P.R. China.
² Research Center of Digestive Disease, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, P.R. China.
³ Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
⁴ Institute of Aging and Age-Related Disease Research, Central South University, Changsha, 410011, Hunan, China.
⁵ Department of Gastroenterology, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, P.R. China. deliangliu@csu.edu.cn.
⁶ Research Center of Digestive Disease, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, P.R. China. deliangliu@csu.edu.cn.
⁷ Department of Gastroenterology, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, P.R. China. tanyuyong@csu.edu.cn.
⁸ Research Center of Digestive Disease, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, P.R. China. tanyuyong@csu.edu.cn.

PMID: 34550437
DOI: 10.1007/s00464-021-08740-3

Abstract

Background: Duodenal subepithelial lesions (D-SELs) are rare and their resection is challenging. Unfortunately, data on surgical and endoscopic resection of D-SELs are scarce. This study aimed to assess the safety and efficacy of surgical resection and endoscopic resection (ER) for D-SELs.

Methods: We retrospectively analyzed clinical data of patients with non-ampullary D-SELs who underwent ER or surgery and compared the outcomes between ER and surgery with no/low-risk SELs over 15 mm from March 2010 to August 2020. Clinicopathologic findings, procedure-related parameters, and follow-up data were analyzed.

Results: A total of 107 patients (108 lesions) were enrolled; 52 patients (53 lesions) received ER and 55 patients (55 lesions) received surgery. In ER group, en bloc resection rate and R0 resection rate were 94 and 89%, respectively. Major adverse events rate was 6%. One (2%) patient experienced local recurrence. In surgery group, R0 resection was achieved in all cases. Major adverse events rate was 20%. Recurrence rate and distant metastases rate were 4 and 8%, respectively. One (2%) patient died from septicemia during follow-up. Thirty-three patients in each group were enrolled in the comparison. There were no significant differences in age, sex, lesion size and location (P > 0.05). More histologically GISTs and muscularis propria-originated lesions were treated by surgery (P < 0.05). ER was significantly associated with a shorter operation time, shorter hospital stay, lower cost, less estimated blood loss, and lower major adverse events rate compared to the surgery group (P < 0.05). However, R0 resection rate, mortality, recurrence rate, and metastases rate were not significant different (P > 0.05).

Conclusions: ER is an effective and safe treatment modality for selected patients with non-ampullary D-SELs by expert endoscopists. Surgery is a radical method for D-SELs that should be reserved for D-SELs not amenable to ER.

Keywords: Duodenum; Endoscopic resection; Subepithelial tumors; Surgery; Treatment.

MeSH terms

Duodenal Neoplasms* / pathology
Duodenal Neoplasms* / surgery
Duodenum / surgery
Endoscopic Mucosal Resection* / methods
Gastrointestinal Stromal Tumors* / pathology
Gastrointestinal Stromal Tumors* / surgery
Humans
Retrospective Studies
Treatment Outcome