North Texas GME Research Forum 2024



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North Texas


Medical City Arlington


General Surgery

Document Type


Publication Date



surgery, duodenal neuroendocrine tumor


Digestive System Diseases | Medicine and Health Sciences | Neoplasms | Surgery


Introduction: Duodenal neuroendocrine carcinomas are an uncommon variant of Neuroendocrine tumors (NETs) that are typically non-functional with locoregional spread at the time of diagnosis. Management of these tumors is dependent on size, grade, stage, functional status and location.

Summary: A 66-year-old male presented with an incidental finding of low grade 3 centimeter duodenal NET on esophagogastroduodenoscopy (EGD) located in the second segment of the duodenum with evidence of lymphadenopathy on staging scans. In patients with suspected lymph node metastases, the first choice for curative intent is a pancreaticoduodenectomy (PD), also known as Whipple Procedure. We achieved surgical resection with free margins of the tumor via Robotic-assisted laparoscopic periampullary sparing duodenectomy with primary repair. In order to achieve preservation of the ampullary region, we identified the ampulla through transcystic duct guidewire insertion.

Case Presentation: A 66-year-old male presented for primary resection of duodenal NET following multiple EGD studies with attempted mucosal resection. He was scheduled for a robotic-assisted Whipple procedure. However at the time of the index operation, a primary resection of the tumor was completed with negative margins without performing the full procedure. Discussion Duodenal NETs often present in the first or second part of the duodenum. Subcentimeter non-ampullary locations are usually amenable to endoscopic resection. Periampullary NETs and duodenal NETs larger than 2 centimeters should be considered for surgical resection via local excision or PD. 20% of D-NETs occurring periampullary require complex procedures such as a PD. PD is the first choice for curative resection for suspected lymph node metastasis such as in our patient.

Conclusion: Primary resection of duodenal NETs can safely be removed robotically without performing life-altering Whipple procedures, even in cases of large tumor burden. These tumors must be located away from the ampullary region of D2, and precaution must be taken to preserve this area with primary closure. Lessons Learned: Preservation of the ampullary region can be achieved safely in robotic-assisted duodenectomy with use of a guidewire to ensure primary closure does not interfere with patency. Negative margins can be achieved safely even in the setting of a large duodenal tumor.

Original Publisher

HCA Healthcare Graduate Medical Education


3rd Place - Case Report Category

Primary Resection of Duodenal Neuroendocrine Tumor with Suspected Lymph Node Metastasis: A Case Report



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