In the current era of endoscopic submucosal dissection (ESD) for early gastric cancer, which carries a negligible risk of lymph node metastasis, local resection of the stomach remains an option for these lesions. This is particularly so for a large intramucosal lesion or a lesion with a strong ulcer scar, for which ESD becomes a difficult option. Here, we describe a case of lateral-spreading intramucosal gastric cancer of 6-cm diameter located at the fornix of the stomach, which was successfully treated by laparoscopic and endoscopic cooperative surgery (LECS) because of the expected risk of complications during ESD. In the LECS procedure, the resection margin was appropriately determined by the endoscopic evaluation in detail and by the ESD technique. If early gastric cancer fits the criteria for endoscopic resection but would present difficulty if performing ESD, this is a good indication for the LECS procedure.

The laparoscopic technique is not only less invasive, but is also similarly safe and curative compared to open gastrectomy.

the procedure, and reports the advantages of laparoscopic surgery by HALS for gastric cancer located in the upper portion of the stomach. Patients and operational methodsBetween March 1998 and March 2002, we had 170 cases of laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer located in the middle or lower third of the stomach. Of these, 104 patients were operated on by HALS and 66 by a totally laparoscopic procedure without HALS. Here, we report on laparoscopic resection by HALS for 28 patients with upper gastric carcinoma between March 1999 and March 2002. All the lesions for which endoscopic mucosal resection or partial gastrectomy were not indicated were thought to be limited to submucosa deep within the tumor, where no evidence of lymph node metastases had been found in preoperative examinations (cT1cN0) ( Table 1). The patients were divided into two groups according to the following criteria: (1) 16 patients (average age 61.4 years; range 40-84 years; male-female ratio 11 : 5) whose lesions were spread in both the upper and middle thirds of the stomach (UM cases) were given total gastrectomy with D2 dissection followed by Roux-en-Y reconstruction; (2) 12 patients (average age 67.6 years; range 48-83 years; male-female ratio 7 : 5) whose lesions were limited to the upper third of the stomach (U cases) were given proximal gastrectomy with D1 dissection followed by esophagogastrostomy, or D2 dissection followed by jejunal interposition. As a general rule, D1 dissection was performed for lesions where the invasion of the submucosa was slight (sm1), while D2 dissection was used for lesions which had massively invaded the submucosa (sm2).The surgeon's left hand was inserted into the peritoneal cavity thorough a transverse skin incision about Abstract Recently, a minimally invasive operation for gastric malignancies has been developed, and this laparoscopic operation is seen as a technique that will raise quality of life for patients. Previously, we reported this technique, as well as the results of a distal gastrectomy with regional lymph node dissection using hand-assisted laparoscopic surgery (HALS) for gastric cancer located in the middle or lower third of the stomach. This paper describes total or proximal gastrectomy with regional lymph node dissection by HALS on 28 cases of gastric cancer located in the upper portion of the stomach. After the mobilization of stomach and lymph node dissection via HALS, an anastomosis of the esophagus was performed intracorporeally with a conventional circular stapling device (PCEEA), whereas jejunojejunostomy and jejunogastrostomy were carried out extracorporeally with a conventional hand-sewn procedure through a HALS wound. The operation time and the amount of blood loss in all the patients were considered to be satisfactory, and the average number of dissected lymph nodes per patient was similar to that in open surgery. The patients had minimal morbidity and quick recovery after their operation. This technique was thought to be not only ...

The laparoscopic technique is not only less invasive, but also similarly safe and curative compared with open gastrectomy.

LAsTG could be a better choice than LATG for EGC in the upper stomach as a result of improvements in the incidence of anastomotic complications and postoperative nutritional status.