Long-Term Survival after Complete Resection of Local Duodenal Recurrence following Colon Cancer Surgery Using Laparoscopic and Endoscopic Cooperation: A Case Report

Abstract

ABSTRACT INTRODUCTION Laparoscopic and endoscopic cooperative surgery (LECS) enables accurate intraluminal localization and limited full-thickness resection while preserving gastrointestinal continuity. Although LECS has been used for selected primary duodenal tumors, its application to a postoperative duodenal recurrence of colorectal cancer has rarely been described. We report a case of localized duodenal recurrence after a right hemicolectomy that was completely resected using laparoscopic and endoscopic cooperation. CASE PRESENTATION An 83-year-old man underwent a laparoscopic right hemicolectomy with a D3 lymph node dissection for advanced ascending colon cancer. Histopathological examination demonstrated a microscopically positive dissected margin on the duodenal side, indicating a microscopically positive margin (R1) resection. Nine months later, surveillance upper gastrointestinal endoscopy and contrast-enhanced CT revealed a solitary lesion in the second portion of the duodenum without distant metastasis or radiological pancreatic involvement. Endoscopic ultrasonography showed a lesion extending to the fourth layer. An upper gastrointestinal contrast study was not performed; instead, the location and local extent of the lesion were assessed by upper gastrointestinal endoscopy, endoscopic ultrasonography, and contrast-enhanced CT. Because the multimodal assessment indicated that complete local excision was technically achievable, LECS was performed. Intraoperative endoscopy delineated a wider intraluminal extent than was apparent from the serosal surface and guided an en bloc full-thickness resection. The defect was closed in the short-axis direction by a continuous full-thickness suturing. Intraoperative endoscopy confirmed the luminal patency and a negative leak test. Histopathological examination showed an adenocarcinoma involving the submucosa and muscularis propria without duodenal mucosal involvement. The adjacent muscularis propria was inverted toward the lumen, suggesting inward progression from the outer aspect of the duodenal wall. Together with the previous R1, these findings supported a localized recurrence from microscopic residual disease. The resection margins were negative, and the patient has remained disease-free for more than 5 years. CONCLUSIONS Laparoscopic and endoscopic cooperation enabled precise definition of the recurrent lesion, complete full-thickness local resection, and secure closure while preserving duodenal continuity. This approach may be useful for strictly localized duodenal recurrence when careful preoperative assessment indicates that complete local excision is achievable.