Laparoscopic Segmental Duodenectomy With Antrectomy as a Feasible Strategy for Proximal Non-ampullary Duodenal Cancer in Octogenarians: A Report of Two Cases.

The optimal therapeutic approach for early-stage non-ampullary duodenal cancer (NADC) remains challenging, particularly for tumors that are difficult to manage with endoscopic resection (ER) but do not strictly require highly invasive pancreaticoduodenectomy (PD). Here, we report two octogenarians with early-stage proximal NADC successfully treated with laparoscopic segmental duodenectomy with antrectomy (LSDA), a procedure that provides oncological radicality while minimizing invasiveness. An 89-year-old woman presented with a 30 mm Borrmann type 1-like tumor extending from the duodenal bulb to the pyloric ring, for which ER or laparoscopy-endoscopy cooperative surgery (LECS) was considered high risk due to tumor location and size. An 85-year-old woman had a tumor with suspected submucosal invasion (T1b) at the superior duodenal angle, and although no lymph node metastasis was evident, PD was considered excessively invasive given her age and frailty. In both cases, LSDA with selective lymph node dissection was safely performed, followed by Billroth II reconstruction. Both patients achieved R0 resection and had uneventful postoperative courses, with discharge within 14 days, and they remain recurrence-free at 58 and 35 months, respectively, with preserved nutritional status and quality of life. LSDA is a function-preserving and oncologically sound treatment option for older adults with early-stage NADC, serving as a versatile approach that bridges the gap between endoscopic treatment and PD.