Early gastric cancer: A challenge in Western countries

Table 3 Laparoscopic endoscopic cooperative procedures

Procedure	Characteristics
Laparoscopic endoscopic cooperative surgery	Endoscopic dissection of the mucosal or submucosal layers with laparoscopic seromuscular resection.
Endoscope-assisted laparoscopic wedge resection	The procedure is performed to remove tumors with a laparoscope after localization by an intraoperative endoscope. EAWR is difficult to implement in sites where strictures may occur, such as pylorus and the gastroesophageal junction.
Laparoscopy-assisted endoscopic resection	The concept of LAER is contrary to that of EAWR. The procedure is an ESD procedure assisted by laparoscopy.
Endoscope-assisted laparoscopic transgastric resection	The procedure involves opening of the gastric wall under the direct view of an endoscope, tagging the tumor with a laparoscopic suture and performing wedge resection with a laparoscopic stapler.
Laparoscopic intragastric surgery	Procedure can be used in laparoscopic surgery performed within the stomach. The incision in the wall of the stomach is minimized and laparoscopic trocars are inserted into the gastric lumen.
Single-incision intragastric resection	This is a single-port laparoscopic surgery.
Endoscopic submucosal dissection with laparoscopic lymph node dissection	This procedure is the same as LAER with laparoscopic perigastric lymph node dissection. The advantage is that the stomach can be preserved. However, the main procedure is ESD, which requires a skilled endoscopist.
Single-incision endoscopic submucosa dissection with laparoscopic lymph node dissection	The procedure is similar to SI-IGR, where sentinel node navigation surgery with unilateral perigastric laparoscopic lymph node dissection is performed with a single-port. Then ESD is performed through a single-port.
Laparoscopy-assisted endoscopic full-thickness resection	If the tumor invades deeper than the muscle layer of the wall of the stomach, full-thickness resection with an endoscope is performed and a laparoscope is used for repair.
Non-exposed wall-inversion surgery	The procedure was developed so that EFTR could be performed without spillage. The disadvantages are that the procedure time is long, as it involves ESD and endoscopic closure, and it is difficult to apply to the pyloric area and gastroesophageal junction.
Clean no-exposure technique	Similar to NEWS, this procedure has also been developed to avoid cancer cell spillage. Clean-NET can be applied to EGCs in most locations, except for pyloric area and gastroesophageal junction.

EAWR: Endoscope-assisted laparoscopic wedge resection; LAER: Laparoscopy-assisted endoscopic resection; ESD: Endoscopic submucosal dissection; EATR: Endoscope-assisted laparoscopic transgastric resection; SI-IGR: Single-incision intragastric resection; EFTR: Endoscopic full thickness resection; NEWS: Non-exposed wall-inversion surgery; Clean-NET: Clean no-exposure technique; EGC: Early gastric cancer.