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Choice of LECS Procedure for Benign and Malignant Gastric Tumors

  • Min, Jae-Seok (Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center) ;
  • Seo, Kyung Won (Department of Surgery, Kosin University Gospel Hospital) ;
  • Jeong, Sang-Ho (Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine)
  • Received : 2021.06.06
  • Accepted : 2021.06.21
  • Published : 2021.06.30

Abstract

Laparoscopic endoscopic cooperative surgery (LECS) refers to the endoscopic dissection of the mucosal or submucosal layers with laparoscopic seromuscular resection. We recommend a treatment algorithm for the LECS procedure for gastric benign tumors according to the protruding type. In the exophytic type, endoscopic-assisted wedge resection can be performed. In the endophytic type, endoscopic-assisted wedge resection of the anterior wall is relatively easy to perform, and endoscopic-assisted transgastric resection, laparoscopic-assisted intragastric surgery, or single-incision intragastric resection in the posterior wall and esophagogastric junction (EG Jx) can be attempted. We propose an algorithm for the LECS procedure for early gastric cancer according to the tumor location. The endoscopic submucosal dissection (ESD) procedure can be adapted for all areas of the stomach, and single-incision ESD can be performed in the mid to high body and the EG Jx. In full-thickness gastric resection, laparoscopy-assisted endoscopic full-thickness resection can be adapted for the entire area of the stomach, but it cannot be applied to the pyloric and EG Jx. In conclusion, surgeons need to select the LECS procedure according to tumor type, tumor location, the surgeon's individual experience, and the situation of the institution while also considering the advantages and disadvantages of each procedure.

Keywords

References

  1. Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008;22:1729-1735. https://doi.org/10.1007/s00464-007-9696-8
  2. Ntourakis D, Mavrogenis G. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: current status. World J Gastroenterol 2015;21:12482-12497. https://doi.org/10.3748/wjg.v21.i43.12482
  3. Abe N, Takeuchi H, Yanagida O, Masaki T, Mori T, Sugiyama M, et al. Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 2009;23:1908-1913. https://doi.org/10.1007/s00464-008-0317-y
  4. Goto O, Takeuchi H, Kitagawa Y, Yahagi N. Endoscopic submucosal dissection (ESD) and related techniques as precursors of "New Notes" resection methods for gastric neoplasms. Gastrointest Endosc Clin N Am 2016;26:313-322. https://doi.org/10.1016/j.giec.2015.12.006
  5. Caron PH, Martins MI, Bertevello PL. Preliminary analysis of hybrid laparoscopic procedure for resection of gastric submucosal tumors. Rev Col Bras Cir 2016;43:129-135. https://doi.org/10.1590/0100-69912016002010
  6. Tan Y, Tan L, Lu J, Huo J, Liu D. Endoscopic resection of gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol 2017;2:115. https://doi.org/10.21037/tgh.2017.12.03
  7. Kim CG. Endoscopic full-thickness resection combined with laparoscopic surgery. Clin Endosc 2018;51:33-36. https://doi.org/10.5946/ce.2017.153
  8. Goto O, Takeuchi H, Kitagawa Y, Yahagi N. Endoscopic submucosal dissection (ESD) and related techniques as precursors of "New Notes" resection methods for gastric neoplasms. Gastrointest Endosc Clin N Am 2016;26:313-322. https://doi.org/10.1016/j.giec.2015.12.006
  9. Kim HH, Uedo N. Hybrid NOTES: combined laparo-endoscopic full-thickness resection techniques. Gastrointest Endosc Clin N Am 2016;26:335-373. https://doi.org/10.1016/j.giec.2015.12.011
  10. Inoue H, Ikeda H, Hosoya T, Yoshida A, Onimaru M, Suzuki M, et al. Endoscopic mucosal resection, endoscopic submucosal dissection, and beyond: full-layer resection for gastric cancer with nonexposure technique (CLEAN-NET). Surg Oncol Clin N Am 2012;21:129-140. https://doi.org/10.1016/j.soc.2011.09.012
  11. Abe N, Takeuchi H, Ooki A, Nagao G, Masaki T, Mori T, et al. Recent developments in gastric endoscopic submucosal dissection: towards the era of endoscopic resection of layers deeper than the submucosa. Dig Endosc 2013;25 Suppl 1:64-70. https://doi.org/10.1111/j.1443-1661.2012.01387.x
  12. Kato M, Nakajima K, Nishida T, Yamasaki M, Nishida T, Tsutsui S, et al. Local resection by combined laparoendoscopic surgery for duodenal gastrointestinal stromal tumor. Diagn Ther Endosc 2011;2011:645609. https://doi.org/10.1155/2011/645609
  13. Qiu WQ, Zhuang J, Wang M, Liu H, Shen ZY, Xue HB, et al. Minimally invasive treatment of laparoscopic and endoscopic cooperative surgery for patients with gastric gastrointestinal stromal tumors. J Dig Dis 2013;14:469-473. https://doi.org/10.1111/1751-2980.12076
  14. Matsuda T, Hiki N, Nunobe S, Aikou S, Hirasawa T, Yamamoto Y, et al. Feasibility of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors (with video). Gastrointest Endosc 2016;84:47-52. https://doi.org/10.1016/j.gie.2015.11.040
  15. Hiki N, Nunobe S, Matsuda T, Hirasawa T, Yamamoto Y, Yamaguchi T. Laparoscopic endoscopic cooperative surgery. Dig Endosc 2015;27:197-204. https://doi.org/10.1111/den.12404
  16. Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 2006;243:738-745. https://doi.org/10.1097/01.sla.0000219739.11758.27
  17. Ye X, Yu J, Kang W, Ma Z, Xue Z. Short- and long-term outcomes of endoscope-assisted laparoscopic wedge resection for gastric submucosal tumors adjacent to esophagogastric junction. J Gastrointest Surg 2018;22:402-413. https://doi.org/10.1007/s11605-017-3628-2
  18. Huang JL, Zheng ZH, Wei HB, Chen TF, Liu JP, Huang Y, et al. Endoscopy-assisted laparoscopic resections for gastric gastrointestinal stromal tumors: a retrospective study. J Laparoendosc Adv Surg Tech A 2017;27:110-114. https://doi.org/10.1089/lap.2016.0068
  19. Wilhelm D, von Delius S, Burian M, Schneider A, Frimberger E, Meining A, et al. Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses - analysis of 93 interventions. World J Surg 2008;32:1021-1028. https://doi.org/10.1007/s00268-008-9492-1
  20. Basso N, Rosato P, De Leo A, Picconi T, Trentino P, Fantini A, et al. Laparoscopic treatment of gastric stromal tumors. Surg Endosc 2000;14:524-526. https://doi.org/10.1007/s004640000021
  21. DE-Quadros LG, Kaiser-Junior RL, Campos JM, Felix VN, Flamini-Junior M, Vecchi M, et al. Laparoendoscopic transgastric resection of subepithelial juxtacardiac tumors. Arq Bras Cir Dig 2017;30:143-146. https://doi.org/10.1590/0102-6720201700020014
  22. Ma JJ, Hu WG, Zang L, Yan XW, Lu AG, Wang ML, et al. Laparoscopic gastric resection approaches for gastrointestinal stromal tumors of stomach. Surg Laparosc Endosc Percutan Tech 2011;21:101-105. https://doi.org/10.1097/SLE.0b013e3182139546
  23. Mahajan NN, Singh Nagpal SJ, Wong Kee Song LM, Blackmon SH. Laparoendoscopic transgastric resection of prepyloric gastrointestinal stromal tumor. Innovations (Phila) 2019;14:66-68. https://doi.org/10.1177/1556984519826413
  24. Tagaya N, Mikami H, Kogure H, Kubota K, Hosoya Y, Nagai H. Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc 2002;16:177-179. https://doi.org/10.1007/s004640080158
  25. Privette A, McCahill L, Borrazzo E, Single RM, Zubarik R. Laparoscopic approaches to resection of suspected gastric gastrointestinal stromal tumors based on tumor location. Surg Endosc 2008;22:487-494. https://doi.org/10.1007/s00464-007-9493-4
  26. Lamm SH, Steinemann DC, Linke GR, Eucker D, Simon T, Zerz A, et al. Total inverse transgastric resection with transoral specimen removal. Surg Endosc 2015;29:3363-3366. https://doi.org/10.1007/s00464-014-4037-1
  27. Na JU, Lee SI, Noh SM. The single incision laparoscopic intragastric wedge resection of gastric submucosal tumor. J Gastric Cancer 2011;11:225-229. https://doi.org/10.5230/jgc.2011.11.4.225
  28. Choi CI, Lee SH, Hwang SH, Kim DH, Jeon TY, Kim DH, et al. Single-incision intragastric resection for upper and mid gastric submucosal tumors: a case-series study. Ann Surg Treat Res 2014;87:304-310. https://doi.org/10.4174/astr.2014.87.6.304
  29. Abe N, Mori T, Takeuchi H, Yoshida T, Ohki A, Ueki H, et al. Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer. Am J Surg 2005;190:496-503. https://doi.org/10.1016/j.amjsurg.2005.05.042
  30. Li H, Zhao LL, Zhang XC, Liu DX, Wang GY, Huo ZB, et al. Combination of endoscopic submucosal dissection and laparoscopic sentinel lymph node dissection in early mucinous gastric cancer: Role of lymph node metastasis. World J Clin Cases 2020;8:3474-3482. https://doi.org/10.12998/wjcc.v8.i16.3474
  31. Bok GH, Kim YJ, Jin SY, Chun CG, Lee TH, Kim HG, et al. Endoscopic submucosal dissection with sentinel node navigation surgery for early gastric cancer. Endoscopy 2012;44:953-956. https://doi.org/10.1055/s-0032-1310162
  32. Eom BW, Yoon HM, Min JS, Cho I, Park JH, Jung MR, et al. Prospective multicenter feasibility study of laparoscopic sentinel basin dissection after endoscopic submucosal dissection for early gastric cancer: SENORITA 2 trial protocol. J Gastric Cancer 2019;19:157-164. https://doi.org/10.5230/jgc.2019.19.e12
  33. An JY, Min JS, Hur H, Lee YJ, Cho GS, Park YK, et al. Laparoscopic sentinel node navigation surgery versus laparoscopic gastrectomy with lymph node dissection for early gastric cancer: short-term outcomes of a multicentre randomized controlled trial (SENORITA). Br J Surg 2020;107:1429-1439. https://doi.org/10.1002/bjs.11655
  34. Park JY, Kim YW, Ryu KW, Nam BH, Lee YJ, Jeong SH, et al. Assessment of laparoscopic stomach preserving surgery with sentinel basin dissection versus standard gastrectomy with lymphadenectomy in early gastric cancer-A multicenter randomized phase III clinical trial (SENORITA trial) protocol. BMC Cancer 2016;16:340. https://doi.org/10.1186/s12885-016-2336-8
  35. Jeong SH, Lee YJ, Yoo MW, Park ST, Choi SK, Hong SC, et al. Comparison of hybrid natural orifice transluminal endoscopic surgery and single-port laparoscopic surgery for sentinel node basin dissection in a porcine model. J Laparoendosc Adv Surg Tech A 2012;22:132-138. https://doi.org/10.1089/lap.2011.0319
  36. Jeong SH, Park JH, Yoo MW, Choi SK, Hong SC, Jung EJ, et al. Feasibility of the trans-umbilical route compared with the trans-oral route in gastric upper body endoscopic submucosal dissection: a porcine model. Surg Endosc 2014;28:515-523. https://doi.org/10.1007/s00464-013-3196-9
  37. Jeong SH, Min JS, Park JH, Hong SC, Jung EJ, Ju YT, et al. Safety and location analysis of transumbilical endoscopic submucosal dissection with single-basin lymph node dissection in the upper gastric body: a porcine model. Surg Endosc 2020;34:590-597. https://doi.org/10.1007/s00464-019-06801-2
  38. Lim SG, Hur H, Han SU, Lee KM, Kang JK, Shin SJ, et al. Laparoscopy-assisted endoscopic full-thickness resection for gastric subepithelial tumors originated from the muscularis propria layer: a pilot study with literature review. Scand J Gastroenterol 2017;52:257-263. https://doi.org/10.1080/00365521.2016.1230778
  39. Mahawongkajit P, Chanswangphuvana P. Laparoscopy-assisted endoscopic full-thickness resection of upper gastrointestinal subepithelial tumors: a single-center early experience. Mol Clin Oncol 2020;12:461-467.
  40. Kim CG. Endoscopic full-thickness resection combined with laparoscopic surgery. Clin Endosc 2018;51:33-36. https://doi.org/10.5946/ce.2017.153
  41. Nunobe S, Hiki N, Gotoda T, Murao T, Haruma K, Matsumoto H, et al. Successful application of laparoscopic and endoscopic cooperative surgery (LECS) for a lateral-spreading mucosal gastric cancer. Gastric Cancer 2012;15:338-342. https://doi.org/10.1007/s10120-012-0146-5
  42. Cho WY, Kim YJ, Cho JY, Bok GH, Jin SY, Lee TH, et al. Hybrid natural orifice transluminal endoscopic surgery: endoscopic full-thickness resection of early gastric cancer and laparoscopic regional lymph node dissection--14 human cases. Endoscopy 2011;43:134-139. https://doi.org/10.1055/s-0030-1255955
  43. Mitsui T, Goto O, Shimizu N, Hatao F, Wada I, Niimi K, et al. Novel technique for full-thickness resection of gastric malignancy: feasibility of nonexposed endoscopic wall-inversion surgery (news) in porcine models. Surg Laparosc Endosc Percutan Tech 2013;23:e217-e221.
  44. Eom BW, Kim CG, Kook MC, Yoon HM, Ryu KW, Kim YW, et al. Non-exposure simple suturing endoscopic full-thickness resection with sentinel basin dissection in patients with early gastric cancer: the SENORITA 3 pilot study. J Gastric Cancer 2020;20:245-255. https://doi.org/10.5230/jgc.2020.20.e22
  45. Goto O, Mitsui T, Fujishiro M, Wada I, Shimizu N, Seto Y, et al. New method of endoscopic full-thickness resection: a pilot study of non-exposed endoscopic wall-inversion surgery in an ex vivo porcine model. Gastric Cancer 2011;14:183-187. https://doi.org/10.1007/s10120-011-0014-8
  46. Goto O, Takeuchi H, Kawakubo H, Matsuda S, Kato F, Sasaki M, et al. Feasibility of non-exposed endoscopic wall-inversion surgery with sentinel node basin dissection as a new surgical method for early gastric cancer: a porcine survival study. Gastric Cancer 2015;18:440-445. https://doi.org/10.1007/s10120-014-0358-y
  47. Mahawongkajit P, Techagumpuch A, Suthiwartnarueput W. Non-exposed endoscopic wall-inversion surgery for a gastrointestinal stromal tumor of the stomach: a case report. Oncol Lett 2017;14:4746-4750. https://doi.org/10.3892/ol.2017.6787
  48. Kanehira E, Kanehira AK, Tanida T, Takahashi K, Obana Y, Sasaki K. Clean-NET: a modified laparoendoscopic wedge resection of the stomach to minimize the sacrifice of innocent gastric wall. Surg Endosc 2020;34:290-297. https://doi.org/10.1007/s00464-019-06765-3
  49. Kato M, Uraoka T, Isobe Y, Abe K, Hirata T, Takada Y, et al. A case of gastric adenocarcinoma of fundic gland type resected by combination of laparoscopic and endoscopic approaches to neoplasia with nonexposure technique (clean-NET). Clin J Gastroenterol 2015;8:393-399. https://doi.org/10.1007/s12328-015-0619-2
  50. Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004;60:114-117. https://doi.org/10.1016/S0016-5107(04)01309-4
  51. Seo WJ, Son T, Roh CK, Cho M, Kim HI, Hyung WJ. Reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection for gastric cancer: a modified technique using Single-Site® and two additional ports. Surg Endosc 2018;32:3713-3719. https://doi.org/10.1007/s00464-018-6208-y
  52. Song JH, Son T, Lee S, Choi S, Cho M, Kim YM, et al. D2 lymph node dissections during reduced-port robotic distal subtotal gastrectomy and conventional laparoscopic surgery performed by a single surgeon in a high-volume center: a propensity score-matched analysis. J Gastric Cancer 2020;20:431-441. https://doi.org/10.5230/jgc.2020.20.e36
  53. Seo WJ, Son T, Shin H, Choi S, Roh CK, Cho M, et al. Reduced-port totally robotic distal subtotal gastrectomy for gastric cancer: 100 consecutive cases in comparison with conventional robotic and laparoscopic distal subtotal gastrectomy. Sci Rep 2020;10:16015. https://doi.org/10.1038/s41598-020-73118-9
  54. Park JH, Jeong SH, Lee YJ, Kim TH, Kim JM, Kim DH, et al. Safety and efficacy of post-anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrectomy for gastric cancer. Surg Endosc 2020;34:5312-5319. https://doi.org/10.1007/s00464-019-07319-3