Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2022; 14(8): 508-511
Published online Aug 16, 2022. doi: 10.4253/wjge.v14.i8.508
Laparoscopic and endoscopic cooperative surgery for full-thickness resection and sentinel node dissection for early gastric cancer
Serafino Vanella, Maria Godas, Joaquim Costa Pereira, Ana Pereira, Ivano Apicella, Francesco Crafa
Serafino Vanella, Maria Godas, Ana Pereira, Ivano Apicella, Francesco Crafa, Department of General and Oncology Surgery, St. Giuseppe Moscati Hospital, Avellino 83100, Italy
Joaquim Costa Pereira, Ana Pereira, Department of General Surgery, Hospital de Braga, Braga 4710-243, Portugal
Author contributions: Vanella S designed the study; Godas M, Pereira AM, and Apicella I conducted the study; Crafa F and Pereira JC revised the letter.
Conflict-of-interest statement: All the authors declare no conflicts of interest.
Open-Access: This article 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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Serafino Vanella, MD, PhD, Surgical Oncologist, Department of General and Oncology Surgery, St. Giuseppe Moscati Hospital, C.da Amoretta, Avellino 83100, Italy. nekroma@yahoo.it
Received: March 8, 2022
Peer-review started: March 8, 2022
First decision: April 13, 2022
Revised: April 28, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: August 16, 2022
Processing time: 159 Days and 20.2 Hours
Abstract

The endoscopic submucosal dissection (ESD) technique has become the gold standard for submucosal tumors that have negligible risk of lymph node metastasis (LNM), due to its minimal invasiveness and ability to improve quality of life. However, this technique is limited in stage T1 cancers that have a low risk of LNM. Endoscopic full thickness resection can be achieved with laparoscopic endoscopic cooperative surgery (LECS), which combines laparoscopic gastric wall resection and ESD. In LECS, the surgical margins from the tumor are clearly achieved while performing organ-preserving surgery. To overcome the limitation of classical LECS, namely the opening of the gastric wall during the procedure, which increases the risk of peritoneal tumor seeding, non-exposed endoscopic wall-inversion surgery was developed. With this full-thickness resection technique, contact between the intra-abdominal space and the intragastric space was eliminated.

Keywords: Endoscopic submucosal dissection; Laparoscopic endoscopic cooperative surgery; Non-exposed endoscopic wall-inversion surgery; Early gastric cancer; Nodal basin evaluation

Core Tip: The initial indication for laparoscopic endoscopic cooperative surgery (LECS) was gastric submucosal tumors (SMTs) without ulcerative features. Later, the LECS procedure was expanded to include gastric SMTs with ulceration and gastric cancer (GC) with negligible risk of lymph node metastasis. Currently, LECS can be applied to early GC in which sentinel node (surgical nodal basin) dissection can be performed with intra-operative evaluation by one-step nucleic acid amplification. Modified LECS procedures have been developed, such as inverted LECS, non-exposed endoscopic wall-inversion surgery, a combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique, and closed LECS.