A Case of Early-stage Duodenal Bulb Cancer Treated with Laparoscopic Limited Distal Gastrectomy

Abstract

A case of early-stage duodenal bulb cancer is presented. The patient was an asymptomatic 64-year-old man. He was referred to our hospital because of elevated tumor marker levels, a protruding lesion in the duodenal bulb detected on gastric endoscopy, and a small nodular shadow of the right lung on computed tomography. The histological diagnosis of the biopsy of the duodenal lesion was suspicion of cancer. The right lung nodular shadow seemed to be primary lung cancer. After discussion with respiratory physicians and surgeons, laparoscopic limited distal gastrectomy was performed first. The pathological examination showed gastric-type adenocarcinoma invading to the submucosa with no lymph node metastasis. The appropriate surgical procedure for duodenal bulb cancer has been the subject of debate. For patients with advanced duodenal cancer, pancreaticoduodenectomy is often performed. However, considering the burden on the patients and the complications following extended surgery, limited surgery might be feasible for early-stage cancer.