Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2018; 10(11): 381-397
Published online Nov 15, 2018. doi: 10.4251/wjgo.v10.i11.381
Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits
Yuki Aisu, Daiki Yasukawa, Yusuke Kimura, Tomohide Hori
Yuki Aisu, Department of Digestive Surgery, Tenri Hospital, Tenri 632-8552, Nara, Japan
Daiki Yasukawa, Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
Yusuke Kimura, Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
Tomohide Hori, Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
Author contributions: Aisu Y and Hori H wrote this review and contributed equally to this work; Aisu Y originally drew all schemas; all authors assessed previous papers and provided academic opinions. Aisu Y, Yasukawa D and Hori T performed the laparoscopic surgery; Hori T supervised this review; all authors approved the final version of the manuscript.
Conflict-of-interest statement: No author has potential conflicts of interest.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Tomohide Hori, MD, PhD, Assistant Professor, Attending Doctor, Doctor, Surgeon, Department of Surgery, Shiga General Hospital, 5-4-30 Moriyama, Moriyama 524-8524, Shiga, Japan.
Telephone: +81-77-5825031 Fax: +81-77-5825031
Received: August 22, 2018
Peer-review started: August 22, 2018
First decision: August 31, 2018
Revised: September 15, 2018
Accepted: October 11, 2018
Article in press: October 12, 2018
Published online: November 15, 2018
Processing time: 86 Days and 2.5 Hours

Laparoscopic and endoscopic cooperative surgery (LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors (GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to avoid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according to the concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.

Keywords: Minimally invasive surgery, Laparoscopic and endoscopic cooperative surgery, Facility-based, Gastrointestinal stromal tumor, Early gastric cancer

Core tip: Laparoscopic and endoscopic cooperative surgery (LECS) was first described as a treatment of gastric submucosal tumors in 2008, although a similar concept had been developed before that time. Thereafter, many researchers described LECS as a feasible technique for gastric resection, regardless of tumor location. LECS is a novel procedure that minimizes invasive damage to patients and preserves physiologic function of the residual stomach while securing oncological benefit. Currently, many physicians can fully utilize the advantages of LECS for gastric submucosal tumors located even at the esophagogastric junction by avoiding conventional total gastrectomy or proximal gastrectomy. This technique requires close cooperation between skilled surgeons and experienced endoscopists. Therefore, many tips and pitfalls should be discussed to accelerate this collaboration during LECS. We hope that the herein-described tips will benefit laparoscopic surgeons and interventional endoscopists who are interested in LECS.