A case of gastric adenocarcinoma of fundic gland type resected by combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET)

Abstract

A male in his eighties attended our hospital for further evaluation of gastric cancer. A gastroscopy revealed a whitish flat elevated lesion (Paris, 0-IIa) of 15 mm in diameter on the greater curvature of the proximal fornix. The preoperative diagnosis was intra-mucosal differentiated gastric cancer, and a novel therapeutic approach, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) was applied and the lesion was resected in a single piece without any complications. Histopathological findings revealed atypical glandular epithelium proliferated in the mucosa and shallow layer (300 μm) of submucosa. These cells stained positive for pepsinogen-I and the final diagnosis was gastric cancer of fundic gland type (GAFT). There was no lymph-vascular involvement and free horizontal and vertical margins were confirmed. CLEAN-NET could be a therapeutic option for GAFT at low risk of lymph node metastasis because it prevents excess wall defect and exposure of cancer cells into the peritoneal cavity.

Potential for local resection with sentinel node basin dissection for early gastric cancer based on the distribution of primary sites

“…Comparison between standard gastrectomy with lymphadenectomy and function-preserving surgery with SNBD has been recently reported [27,28], although these studies did not include cases with these procedures. However, the feasibility of these procedures for gastric submucosal tumors and gastric cancer has been demonstrated previously [8,19,24,29]. SNNS-based function-preserving and limited surgery is expected to be more effective by using local resection techniques, such as these methods; however, there may be some technical limitations.…”

Gastric adenocarcinoma of the fundic gland (chief cell-predominant type): A review of endoscopic and clinicopathological features

“…Applying this guideline to reported GA-FG-CCPs, several cases did not meet curative criteria based on the depth of massive submucosal invasion. Considering the high frequency of submucosal invasion, Kato et al[15] suggested the efficacy of the combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), a form of non-exposure laparoscopy and endoscopy cooperative surgery (LECS). CLEAN-NET may represent a therapeutic option for GA-FG-CCP because it facilitates easy resection of tumors located in the upper third of stomach, whereas ESD is technically challenging.…”

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

“…Table 1 provides details of the previous 10 cases of gastric cancer that underwent LECS and our present case. [3][4][5][6] Of these 11 reports, eight cases were in men and three in women. The patients had a median age of 75 years (range, 66-91 years), and the median tumor size was 20 mm (range, 5-60 mm).…”