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Laparoscopic Pancreaticoduodenectomy with Transanal Specimen Extraction for Periampullary Tumors. OBJECTIVE: To explore the possibility of laparoscopic pancreaticoduodenectomy (LPD) with transanal specimen extraction for periampullary tumors. BACKGROUND: Natural orifice specimen extraction (NOSE) has been widely performed in colorectal surgery. But so far there is no report regarding NOSE in LPD. METHODS: Data of 3 patients who underwent LPD with transanal specimen extraction by the same surgeon between July 2018 to March 2019 due to periampullary tumors were evaluated retrospectively. RESULTS: All patients underwent LPD with no conversion to open surgery. Specimens were all extracted transanally. No complications occurred except for delayed gastric emptying in one patient. The patients' anorectal function was intact and no opioids were required postoperatively. After a follow-up of 17-25 months, all patients were alive with no tumor recurrence. CONCLUSION: Treatment of periampullary tumors by LPD with transanal specimen extraction is feasible and safe.