Clinical Impact of Laparoscopy and Endoscopy Cooperative Surgery (LECS) on Gastric Submucosal Tumor After its Standardization.
OBJECTIVE
Laparoscopy and endoscopy cooperative surgery (LECS) is an excellent surgical procedure that utilizes the advantages of both methods. This study was designed in our hospital to evaluate the clinical usefulness of LECS for the removal of gastric submucosal tumors after its standardization.


METHODS
Between 2007 and 2015, 62 consecutive patients underwent surgical resection for gastric submucosal tumors. LECS has been standardized since 2010.


RESULTS
(i) There were no significant differences in background factors between patients (such as sex, age, body mass index (BMI), tumor size and postoperative complications), before or after the standardization of LECS. However, after the standardization of LECS, patients had a lower incidence of gastrectomy and wedge resection (WR) (p<0.001), a smaller amount of blood loss (p=0.001) and a shorter hospital stay after surgery (p<0.001) than those before standardization. (ii) LECS was associated with a significantly shorter maximum surgical margin of resected tumors (p=0.020, LECS vs. WR=10.0 vs. 15.0 mm) compared to WR. Patients with upper-third tumors were more frequently treated by LECS than by WR (p=0.014; LECS vs. WR=76 % vs. 27 %).


CONCLUSIONS
Standardization of LECS contributes to reduction of unnecessary gastrectomy for gastric submucosal tumors. In particular, LECS may have merit in the removal of upper-third tumors by avoiding wedge resection, which carries the risk of excessive resection and deformity of the stomach.
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan skomatsu@koto.kpu-m.ac.jp.
Shuhei
S
Komatsu
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Daisuke
D
Ichikawa
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Toshiyuki
T
Kosuga
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Kazuma
K
Okamoto
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hirotaka
H
Konishi
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Atsushi
A
Shiozaki
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hitoshi
H
Fujiwara
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Osamu
O
Dohi
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan Department of Gastroenterology, Murakami Memorial Hospital, Gifu, Japan.
Nobuaki
N
Yagi
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Eigo
E
Otsuji
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
GIST; LECS; submucosal tumor; wedge resection