Hybrid surgery for early gastric cancer

Abstract

Endoscopic submucosal dissection (ESD) is the most suitable treatment option in terms of minimally invasive treatment for potential node-negative early gastric cancers (EGCs). Furthermore, making the resection area of the primary lesion as small as possible is ideal for the patient's quality of life, even for potential node-positive EGC. An endoluminal approach is a reasonable option with which to minimize stomach resection area, because this procedure can be accurately demarcated from the inside. From this point of view, endoscopic full-thickness resection (EFTR) may be optimal, while laparoscopic assistance would be more desirable to create a more secure procedure. However, hybrid EFTR for EGCs has two limitations, which must be solved. First, concerns regarding iatrogenic tumor seeding via transluminal communication between the inside and outside of the tract exist. The second limitation relates to the determination of lymphadenectomy. Conventional lymphadenectomy, which involves the removal of the majority of feeding arteries, can lead to necrosis of the remaining gastric wall. Therefore, the resection area of lymphadenectomy should also be carefully determined. To address these two problems, a non-exposed hybrid EFTR combined with sentinel node navigation surgery (SNNS) would be the most ideal method of minimally invasive surgery for EGCs.

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

“…Goto et al reported NEWS for early gastric cancer in combination with sentinel node (SN) navigation surgery. The SN is defined as the first lymph node that receives lymphatic drainage from the primary tumor site.…”

Function-Preserving Surgery in Gastric Cancer

“…Endoscopic full-thickness resection (EFTR) is usually done with laparoscopic assistance to facilitate safe resection of the lesion, repair of the ensuing defect, and even limited lymph node dissection. 49 Dissection is done intraluminally with submucosal injection and circumferential endoscopic mucosal incision, followed by intentional perforation to facilitate complete full thickness resection under laparoscopic countertraction. 50 Iatrogenic tumor seeding is a concern with this procedure since there is a possibility of tumor cells in the gastric juice to spread by spillage or by contact of exposed surface of the lesion with the peritoneum or laparoscopic instruments.…”

“…50 Iatrogenic tumor seeding is a concern with this procedure since there is a possibility of tumor cells in the gastric juice to spread by spillage or by contact of exposed surface of the lesion with the peritoneum or laparoscopic instruments. 49 Non-exposure techniques for full-thickness resection have been developed to prevent iatrogenic seeding such as wedge resection, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), and non-exposed endoscopic wall-inversion surgery (NEWS). 49…”

“…49 Non-exposure techniques for full-thickness resection have been developed to prevent iatrogenic seeding such as wedge resection, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), and non-exposed endoscopic wall-inversion surgery (NEWS). 49…”

Laparoscopic endoscopic cooperative surgery (LECS) for the upper gastrointestinal tract

“…Goto et al reported NEWS for early gastric cancer in combination with sentinel node (SN) navigation surgery (12,18). The SN is the first lymph node that receives lymphatic drainage from the primary tumor.…”