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Updated: Jul 16, 2026
Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors
Published on: February 19, 2022
Non-exposure LECS (CLEAN-NET) for gastric cancer: long-term outcomes of a function-preserving strategy with selective
Manabu Onimaru1, Haruhiro Inoue2, Kenta Nakahara3
1Digestive Diseases Center, Showa Medical University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-Ku, Tokyo, 135-8577, Japan. mnbonmr0827@gmail.com.
Background:
Non-exposure laparoscopic and endoscopic cooperative surgery (LECS), known as CLEAN-NET (combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique), was developed for gastric submucosal tumors; however, its oncologic validity for gastric cancer remains unclear. We evaluated long-term oncologic outcomes of CLEAN-NET in patients with clinically diagnosed cT1N0 gastric cancer during the early developmental phase of this technique.
Methods:
We retrospectively analyzed 19 consecutive patients who underwent CLEAN-NET between December 2008 and June 2010. Treatment selection was based on preoperative clinical staging available at that time. Limited regional lymph node assessment was performed in selected cases, and pathological findings were classified according to the eCura system. Recurrence of the gastric cancer treated by CLEAN-NET, metachronous gastric cancer, overall survival, and causes of death were evaluated.
Results:
The median follow-up period was 6.2 years, with follow-up extending up to 16.8 years. Although treatment selection was based on preoperative cT1N0 assessment, 14 patients (73.7%) were subsequently classified as eCuraC-2 because of postoperative pathological risk factors. Limited regional lymph node dissection was performed in 15 patients, and pathological lymph node metastasis was identified in 1 patient. Additional surgery was performed in 3 patients. No recurrence of the gastric cancer treated by CLEAN-NET was observed. Metachronous gastric cancer developed in the preserved stomach in 2 patients, including 1 death from metachronous gastric cancer. During follow-up, 3 patients died: 1 from lung cancer, 1 from metachronous gastric cancer, and 1 from pneumonia.
Conclusion:
This historical cohort provides rare ultra-long-term observational data after CLEAN-NET for gastric cancer. Although no recurrence of the gastric cancer treated by CLEAN-NET was observed, the findings do not establish CLEAN-NET as an alternative to guideline-recommended gastrectomy. Rather, they may inform future studies of function-preserving, non-exposure local resection combined with validated nodal navigation strategies.
