Laparoscopic endoscopic cooperative surgery (LECS) for the gastrointestinal tract: Updated indications

Abstract

Laparoscopic and endoscopic cooperative surgery (LECS) is a procedure combining laparoscopic gastric resection with endoscopic submucosal dissection for local resection of gastric tumors with appropriate, minimal surgical resection margins. The LECS concept was initially developed from the classical LECS procedure for gastric submucosal tumor resection. Many researchers reported that classical LECS was a safe and feasible technique for resection of gastric submucosal tumors, regardless of tumor location, including the esophagogastric junction. Recently, LECS was approved for insurance coverage by Japan's National Health Insurance plan and widely applied for gastric submucosal tumor resection. However, the limitations of classical LECS are the risk of abdominal infection, scattering of tumor cells in the abdominal cavity, and tumor cell seeding in the peritoneum. The development of modified LECS procedures, 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, has almost resolved these drawbacks. This has led to a recent increase in the indication of modified LECS to include patients with gastric epithelial neoplasms. The LECS concept is also beginning to be applied to tumor excision in other organs, such as the duodenum, colon and rectum. Further evolution of LECS procedures is expected in the future. Sentinel lymph node mapping could also be combined with LECS, resulting in a portion of early gastric cancers being treated by LECS with sentinel node mapping.

Laparoscopic‐endoscopic cooperative surgery for a gastric duplication cyst in the prepyloric region to preserve the pylorus ring in a child: A case report

“…To overcome these challenges, some modified LECS procedures with nonexposure techniques have been developed recently mainly for gastric epithelial neoplasms. 8 In the present case, these newly developed procedures might have been a better option, although an actual malignant transformation is exceedingly rare for a gastric duplication cyst and there have been no previous reports of neoplasm arising from a gastric duplication cyst in children. 9 In conclusion, complete surgical resection of a gastric duplication cyst in the prepyloric region in a child was successfully performed by LECS.…”

“…Our procedure using classical LECS, which combined laparoscopic gastric resection with ESD for local resection of gastric tumors with appropriate, minimal surgical resection margins, has some limitations. 8 Splashing gastric contents could cause postoperative abdominal infection. More importantly, our procedure had the risk of scattering tumor cells.…”

Laparoscopic‐endoscopic cooperative surgery for early gastric cancer with gastroesophageal varices

“…LECS was first described as a treatment for gastric submucosal tumors in 2008, 7 and since then, many researchers have described it as a feasible technique for gastric resection regardless of tumor location. 2,8 LECS involves endoscopic dissection from the mucosal layer to the submucosal layer and then laparoscopic seromuscular resection, regardless of tumor location. Incision lines are determined and the mucosalto-submucosal incision is performed endoscopically, whereas the seromuscular layer is incised and the incision line is closed laparoscopically.…”

“…3 Inverted LECS was developed to avoid the scattering of gastric juice and contact between the tumor and the surrounding tissue. 2,3 Combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique, known as CLEAN-NET, 9 and non-exposed endoscopic wall-inversion surgery are non-exposure full-thickness resection techniques for the gastric wall that can prevent the risk of cancer cells seeding during the procedure. 10 In conclusion, LECS is a suitable therapeutic option for the precise dissection of gastrointestinal tumors, but it may also be appropriate for EGC in select patients for whom ESD would be difficult, such as in this case.…”

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

“…78 In Japan, laparoscopic endoscopic cooperative surgery (LECS), combining the technique of ESD and laparoscopic gastric wall resection, has been safely applied to patients with gastric submucosal tumors. 80 In addition, non-exposed endoscopic wall-inversion surgery (NEWS), which is a modified LECS procedure, [81][82][83][84][85] has been developed for application to cancers without risk of iatrogenic dissemination as there is no requirement for intentional perforation during the procedure. 83 Goto et al 83 reported a favorable short-term outcome in a case with EGC who underwent NEWS with laparoscopic SN sampling.…”