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Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors
Published on: February 19, 2022
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Laparoscopic endoscopic cooperative surgery (LECS) for the upper gastrointestinal tract
Tatsuo Matsuda1,2, Souya Nunobe1, Manabu Ohashi1
1Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Translational Gastroenterology and Hepatology
|June 16, 2017
Summary
Laparoscopic and endoscopic cooperative surgery (LECS) effectively resects gastric submucosal tumors. Modified LECS techniques expand its use for gastric neoplasms, with future potential for early gastric cancer using sentinel node navigation surgery.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic and endoscopic cooperative surgery (LECS) combines endoscopic submucosal dissection (ESD) and laparoscopic gastric resection for gastric submucosal tumors (SMTs).
- LECS is recognized as a feasible technique for SMT resection across various gastric locations, including the esophagogastric junction (EGJ).
- Recent Japanese National Health Insurance approval signifies widespread adoption and clinical utility of LECS.
Purpose of the Study:
- To review the development and application of Laparoscopic and Endoscopic Cooperative Surgery (LECS) for gastric submucosal tumors (SMTs) and epithelial neoplasms.
- To discuss modifications of the LECS technique to broaden its indications and improve safety.
- To explore future integration of LECS with sentinel node navigation surgery (SNNS) for early gastric cancer treatment.
Main Methods:
- Initial application of "classical LECS" for SMTs without ulcerative lesions to mitigate peritoneal seeding risk.
- Development and application of modified LECS techniques: inverted LECS, non-exposed endoscopic wall-inversion surgery (NEWS), CLEAN-NET, and closed-LECS.
- Proposed combination of modified LECS with sentinel node navigation surgery (SNNS) for clinical Stage IA gastric cancer.
Main Results:
- LECS has demonstrated feasibility for gastric submucosal tumor resection, including at the esophagogastric junction.
- Modified LECS procedures have successfully expanded indications to include gastric epithelial neoplasms.
- The integration of modified LECS with SNNS presents a promising minimally invasive approach for early gastric cancer.
Conclusions:
- LECS is an established and effective technique for resecting gastric submucosal tumors.
- Evolving modified LECS techniques enhance safety and broaden applicability for various gastric neoplasms.
- Future research directions focus on combining LECS with SNNS for minimally invasive resection of early gastric cancer.
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