Laparoscopic and endoscopic cooperative surgery for advanced gastric cancer as palliative surgery in elderly patients: a case report

Abstract

Background The number of elderly patients with gastric cancer is increasing, with the very elderly often refusing radical gastrectomy with lymph node dissection. Such a patient presented to us and we proposed a palliative surgery involving gastric local resection using laparoscopy endoscopy cooperative surgery (LECS). Case presentation An 89-year-old woman presented to our hospital with progressing anemia. She had an aortic arch replacement for aortic dissection 6 months previously and was taking antithrombotic drugs for atrial fibrillation. She was diagnosed with advanced gastric cancer, and we presented a radical resection treatment plan involving distal gastrectomy with lymph node dissection. However, she strongly refused undergoing radical gastric cancer resection. We believed that at least local control of the tumor could be effective in preventing future bleeding or stenosis due to tumor progression. Therefore, we proposed a local gastrectomy with LECS as an optional treatment, and she agreed to this treatment. The surgery was performed with minimal blood loss, and no postoperative complications were observed. Histopathological examination revealed a 45 × 31-mm, Type 2, poorly differentiated adenocarcinoma (pT4a, ly0, v1a), and the resected margin was negative. The patient was alive 2 years after surgery without apparent recurrence or other illness. In addition, her weight was maintained, together with her daily activity. Conclusion Local resection of gastric cancer with LECS might be an option for the palliative treatment of patients who refuse radical resection of gastric cancer.

Ingenuity and tips for laparoscopic local resection for local recurrence of early gastric cancer after endoscopic submucosal dissection: A case report

“…Although distal gastrectomy with lymph node dissection was the most adequate treatment, we performed LLR for local recurrence due to the patient's comorbidities. Recently, there have been an increasing number of case reports of local resection for gastric cancer in high-risk perioperative patients due to old age or comorbidities [1] , [2] , [10] . The extent of gastric resection and lymph node dissection is limited, resulting in less morbidity and early recovery compared with distal gastrectomy.…”

“…Particularly, elderly people and patients with severe comorbidities have a high-risk of mortality and complication; consequently, a less invasive surgery, and not a typical gastrectomy, may be beneficial for them. Some studies have reported partial gastrectomy using laparoscopic and endoscopic cooperative surgery (LECS) as a palliative treatment for gastric cancer [1] , [2] , [3] . Here, we report our experience and tips for laparoscopic local resection (LLR), without the need for endoscopic submucosal dissection (ESD), for treating gastric cancer in a patient with severe comorbidities.…”

Laparoscopic and Endoscopic cooperative surgery as Rescue-treatment for Advanced gastric Cancer in patients Unfit for Surgery (LE-RACUS): protocol for a phase 1 clinical study

“…In Japan, the current indication for LECS is gastrointestinal stromal cell tumors (GIST) with a size of 2-5 cm. LECS has also been described in two case reports as palliative treatment for patients with AGC without being in a state to undergo gastrectomy (12)(13). To the best of our knowledge, no prospective trial has studied LECS for this indication.…”

Laparoscopic and endoscopic cooperative surgery for full-thickness resection and sentinel node dissection for early gastric cancer

“…LECS was recently performed in an elderly patient who refused radical surgery as a palliative treatment[ 14 ].…”