Abstract
The patient was an 82-year-old man who had undergone extensive gastrectomy with Billroth-I reconstruction for duodenal ulcer in his twenties. He complained of reflux symptoms and underwent upper gastrointestinal endoscopy, which revealed an elevated lesion with a central depression (5 mm in diameter) on the anterior wall of the greater curvature side of the site of residual stomach-duodenum anastomosis. On a biopsy, the lesion was diagnosed as a G1 neuroendocrine tumor (NET). Endoscopic ultrasonography (EUS) indicated that the tumor had invaded the fourth layer, and the depth of invasion was predicted to be deeper than the lamina propria. Considering the patient's great age, we planned to perform laparoscopic and endoscopic cooperative surgery (LECS) for local resection of the anastomosis site. A sufficient surgical margin from the tumor was secured, and all layers were perforated using a needle knife. Then, the anastomotic site was locally resected under laparoscopy along the perforated marking, and the defect was closed by laparoscopic suturing. Histopathologically, the surgical margin of the resected specimen was negative. The use of LECS for NET at the anastomosis site enabled us to completely resect the tumor and preserve the organ function.
