Laparoscopic and endoscopic cooperative surgery (LECS) is a viable option for managing challenging superficial non-ampullary duodenal tumors, especially those that are larger or more deeply invasive.

• LECS achieved similar complication rates to endoscopic resection, but with a higher en bloc resection rate (97% vs. 95%) and margin-negative resection rates (97% vs. 93%).
• Tumors sized 20mm or greater were linked to a higher risk of endoscopy-related adverse events.

Surgeons should consider LECS for select patients with complex duodenal tumors, incorporating risk factors like tumor size and invasion depth into treatment strategies.