Laparoscopic appendectomy and endoscopic submucosal dissection for lesions in proximity to the appendiceal orifice: A novel organ-preserving strategy
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Published on: March 24, 2023
Daichi Mitsuto1, Takashi Toyonaga2, Tetsuya Yoshizaki2
1Department of Gastroenterology, Toyonaka Keijinkai Hospital.
Background And Aims:
Endoscopic submucosal dissection (ESD) for cecal lesions in proximity to the appendiceal orifice (L-PAO) is technically demanding and associated with risks of incomplete resection and post-ESD appendicitis. We aimed to assess the feasibility and safety of appendectomy-integrated laparoscopic and endoscopic cooperative surgery (A-LECS) as a novel organ-preserving strategy.
Methods:
This retrospective, two-center study included four consecutive patients with L-PAO Type 3 lesions (extending into the appendix) treated with A-LECS between June 2024 and July 2025. The procedure consisted of underwater ESD combined with traction to achieve maximal intraluminal dissection, followed by immediate laparoscopic appendectomy and subsequent endoscopic closure of the cecal defect.
Results:
Technical success was achieved in all cases without conversion to open surgery. The mean ESD procedure time was 116.5 minutes. No procedure-related adverse events, such as perforation, bleeding, or stump appendicitis, occurred. Pathological evaluation confirmed complete resection in all cases (3 SSLs, 1 intramucosal adenocarcinoma). No recurrence was observed in follow-up endoscopy.
Conclusions:
A-LECS may represent a feasible and safe organ-preserving strategy for challenging L-PAO Type 3 lesions that maintains oncological integrity and reduces the risk of post-procedural appendicitis.
