CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(12): E1477-E1485
DOI: 10.1055/a-0761-9494
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Laparoscopic and endoscopic cooperative surgery (LECS) to overcome the limitations of endoscopic resection for colorectal tumors

Yoshiro Tamegai
1  Endoscopic Division, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Yosuke Fukunaga
2  Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Shinsuke Suzuki
2  Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Dennis N.F. Lim
1  Endoscopic Division, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Akiko Chino
1  Endoscopic Division, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Shoichi Saito
1  Endoscopic Division, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Tsuyoshi Konishi
2  Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Takashi Akiyoshi
2  Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Masashi Ueno
2  Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Naoki Hiki
2  Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Tetsuichiro Muto
2  Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 15 March 2018

accepted after revision 24 July 2018

Publication Date:
12 December 2018 (online)

  

Abstract

Background and study aims We developed a laparoscopy endoscopy cooperative surgery (LECS) to overcome the limitations of endoscopic resection for colorectal tumors. The aim of this study was to evaluate the feasibility of LECS, which combines endoscopic submucosal dissection (ESD) and laparoscopic partial colectomy.

Patients and methods We performed LECS for 17 colorectal tumors in 17 patients (male:female 10:7; mean age, 66.5 years). The clinicopathological outcomes of these 17 cases and the feasibility of LECS were evaluated retrospectively. Indications for LECS were as follows: 1) intramucosal cancer and adenoma accompanied by wide and severe fibrosis; 2) intramucosal cancer and adenoma involving the diverticulum or appendix; and 3) submucosal tumors.

Results We successfully performed LECS procedures in 17 cases (intramucosal cancer [n = 6], adenoma [n = 9], schwannoma [n = 1], and gastro-intestinal stromal tumour [GIST] [n = 1]. Mean tumor diameter was 22.4 mm (range, 8 – 41 mm). LECS was successfully performed in all 17 cases without conversion to open surgery; the R0 rate was 100 %. LECS was applied to the following situations: involving the appendix (n = 6), tumor accompanied by severe fibrosis (n = 5), involving the diverticulum (n = 3), submucosal tumor (n = 2), and poor endoscopic operability (n = 1). We experienced no adverse events (e. g., leakage or anastomotic stricture) and the median hospital stay was 6.4 dayus (range, 4 to 12). All 17 patients who were followed for ≥ 3 months (median, 30.8 months; range, 3 – 72 months) showed no residual/local recurrence.

Conclusion LECS was a safe, feasible, minimally invasive procedure that achieved full-thickness resection of colorectal tumors and showed excellent clinical outcomes.