Laparoscopic segmental resection for tumours of the Angle of Treitz: a challenging but feasible surgical option. Results
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ORIGINAL ARTICLE
Laparoscopic segmental resection for tumours of the Angle of Treitz: a challenging but feasible surgical option. Results from a retrospective case‑series analysis Umberto Bracale1 · Emanuele Pontecorvi1 · Vania Silvestri1 · Diego Cuccurullo2 · Michele D’Ambra1 · Ruggero Lionetti1 · Andrea Coppola1 · Filippo Carannante3 · Felice Pirozzi4 · Roberto Peltrini1 · Antonio Sciuto4 · Francesco Corcione1 Received: 14 October 2020 / Accepted: 24 October 2020 © The Author(s) 2020
Abstract Tumours of the small intestine are rare and account for about 5% of gastrointestinal tract neoplasms. The angle of Treitz (AT) could be defined as the intestinal loop comprised between the third duodenal portion and the first 10 cm of jejunum. A gold standard surgical treatment for AT neoplasm has not yet been well defined. This paper is focused on a very rare disease and at the best of our knowledge this is the largest case series in the literature about the Laparoscopic Segmental Resection (LSR) of AT tumours. Using a prospectively collected database, all data of consecutive patients, from January 2007 to May 2019, who underwent LSR for AT tumours at two different institutions were analysed. Patients’ demographics, intra and post-operative data, 30-day mortality and overall survival were collected. A total of 16 patients were retrieved from our database. The mean operative time was 206,5 ± 79 min. Conversion to open surgery was needed in two cases due to tumor size and, respectively, invasion of the transverse colon which required a multivisceral resection. The mean distal and proximal resection margins were 7.4 ± 2.2 and 3.9 ± 1.2 cm. The median number of harvested nodes was 9 ± 3. Pathological diagnosis was GIST in 11 cases, adenocarcinoma in 4 and sarcoma in 1 case. In conclusion, in experienced hands, LSR appears to be a safe and effective treatment option for tumours of the AT. Prospective studies are needed to confirm these findings. Keywords Duodenal cancer · Angle of Treitz · Laparoscopy · Overall survival · GIST · Duodenal segmental resection
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-020-00910-7) contains supplementary material, which is available to authorized users. * Umberto Bracale [email protected] 1
Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
2
Department of General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
3
Department of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
4
Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Italy
Tumours of the small intestine are rare and account for about 5% of gastrointestinal tract neoplasms [1]. Both gastrointestinal stromal tumour (GIST) and adenocarcinoma (ADC) of the angle of Treitz (AT) are even rarer. The AT could be defined as the intestinal loop com
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