title: Feasibility and safety of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors, including esophagogastric junction tumors.
abstract: OBJECTIVE
  Recently, the use of endoscopic submucosal dissection (ESD) for gastric submucosal tumor (gSMT) and the development of laparoscopic and endoscopic cooperative surgery (LECS) have enabled either preservation of the stomach or minimization of the extent of partial resection. In the present study, the outcomes following the recent introduction of LECS for gSMT are presented. The aim of this retrospective study was to evaluate the feasibility and safety of LECS for gSMT, including esophagogastric junction (EGJ) SMT.
  
  
  METHODS
  LECS is indicated for lesions that have an intragastric growth pattern, or for which fundusectomy can be avoided despite an extragastric growth pattern. We retrospectively evaluated the outcome of LECS carried out in 25 patients including five EGJ SMT.
  
  
  RESULTS
  Surgery was completed achieving an R0 resection rate of 100% with no postoperative complications. Mean tumor size was 32.3 ± 13.5 mm and mean resected specimen size was 37.6 ± 13.5 mm. Resection margins were tumor-free in all cases, with adequate minimum surgical margins, and precise conclusive diagnosis was achieved with perfect operative specimens. Endoscopic confirmation of the EGJ enabled the extent of resection to be minimized and the stomach to be preserved, avoiding fundusectomy. Although there were significant differences in tumor size and resected specimen size between EGJ SMT and non-EGJ SMT, there were no significant differences in outcomes of the LECS procedure.
  
  
  CONCLUSIONS
  LECS is feasible and safe for cases with gSMT including lesions adjacent to the EGJ.
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Hoteya
authors.forename: Shusuke
authors.initials: S
authors.lastname: Haruta
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shinohara
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamada
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Furuhata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kikuchi
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Mitani
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iizuka
authors.forename: Harushi
authors.initials: H
authors.lastname: Udagawa
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001706:Biopsy; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: esophagogastric junction; gastric submucosal tumor; laparoscopic and endoscopic cooperative surgery