Research progress in laparoscopic endoscopic cooperative surgery for early gastric cancer: A narrative review

Table 2 Advantages and limitations of different laparoscopic endoscopic cooperative surgery

Surgical strategy	Stripping sequence	Removal method	Suture method	Key benefits	Limitations
Classical LECS	First, the mucosal layer is dissected, followed by dissection of the serosal layer	Abdominal cavity	Mechanical stapler	Precise resection, a relatively straightforward procedure with a short operative duration	Exposure of the gastric cavity may lead to contamination by gastric juice and the implantation and metastasis of tumor cells
Inverted LECS	First, the mucosal layer is dissected, followed by dissection of the serosal layer	Oral cavity	Mechanical stapler	Precise resection; significantly reduced risk of gastric juice contamination, as well as tumor cell implantation and metastasis	There remains exposure of the gastric cavity, and contamination by gastric fluid as well as tumor cell implantation or metastasis cannot be excluded
NEWS	First, the serosal layer is peeled off, followed by the submucosal layer	Oral cavity	Manual suture + endoscopic clips	Precise resection; complete non-exposure technique: Effectively prevents gastric juice contamination, as well as tumor cell implantation and metastasis	The procedure is technically demanding and associated with a prolonged operative duration
CLEAN-NET	The serosal layer, but not the mucosal layer, is dissected	Abdominal cavity	Mechanical stapler	Precise resection; complete non-exposure technique: Effectively prevents gastric juice contamination and tumor cell implantation or metastasis; preservation of mucosal continuity with the tumor encapsulated within the intact mucosa	Determining the appropriate anatomical plane is challenging, which may lead to gastric deformation
Closed LECS	First, the mucosal layer is dissected, followed by dissection of the serosal layer	Oral cavity	Manual suture	Precise resection; complete non-exposure technique: Effective prevention of gastric juice contamination and tumor cell implantation or metastasis; shorter operative duration compared to the two previously described non-exposure methods	Identification of the appropriate anatomical plane is technically challenging
Sealed-EFTR	First, the mucosal layer is dissected, followed by dissection of the serosal layer	Oral cavity	Manual suture	More precise resection margin; temporary serosal sealing: Prevents gastric juice contamination and tumor cell implantation or metastasis	The neoplasm is located at the gastric angulus or along the lesser curvature, which poses a technical challenge for the application of a silicone patch

LECS: Laparoscopic endoscopic cooperative surgery; NEWS: Non-exposed endoscopic wall-inversion surgery; CLEAN-NET: Combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique; EFTR: Sealed endoscopic full-thickness resection.