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Background: Much controversy exists for the treatment of small low-grade non-ampullary duodenal NETs and endoscopically incomplete resected non-ampullary duodenal NETs. In recent years, the development of minimally invasive surgery has spawned a less aggressive treatment option for these patients. We present a case of a 21-year-old patient that was incidentally diagnosed with duodenal NET and treated with laparoscopic-endoscopic salvage surgery after incomplete endoscopic NET resection. Methods: A 21-year-old man was admitted to our hospital for further evaluation and treatment after an incomplete endoscopic resection of a NET in the third portion of the duodenum. The histological examination revealed a moderately differentiated NET with 20 mitoses in 10 high power fields and a Ki-67 index of 3-20%. The tumor extended to the resection margin. The patient was scheduled for a laparoscopic endoscopic full-thickness excision of the tumor remnant. The histological analysis of the surgical specimen revealed fibrotic tissue after previous endoscopic mucosal resection with no residual tumor cells. The patient was discharged on the fifth postoperative day. Conclusion: We showed that in experienced hands the trauma of open surgery can be reduced with a minimally invasive approach without exposing the patients to higher morbidity and excellent long term functional results. Therefore, we believe that in the future laparoscopic-endoscopic cooperative surgery will firmly be established as the treatment of choice for small low-grade and incompletely resected NETs of the non-ampullary duodenum.

Laparoscopic-Endoscopic Surgery for a Non-Ampullary Neuroendocrine Tumor after Incomplete Endoscopical Resection