title: 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.
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan. toshi_urao@yahoo.co.jp.
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.affiliation: Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Isobe
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Hirata
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takada
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Wada
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
authors.forename: Yusaku
authors.initials: Y
authors.lastname: Takatori
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takabayashi
authors.affiliation: Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Fujiyama
authors.affiliation: Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Sekiya
authors.affiliation: Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Department of Pathology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Aoi
authors.initials: A
authors.lastname: Sukeda
authors.affiliation: Department of Pathology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Shiraishi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000369:Aged, 80 and over; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: CLEAN-NET; Full-thickness resection; Fundic gland type; Gastric cancer; LECS