Laparoscopic endoscopic cooperative surgery (<scp>LECS</scp>) for the gastrointestinal tract: Updated indications

AbstractLaparoscopic and endoscopic cooperative surgery (LECS) is a procedure combining laparoscopic gastric resection with endoscopic submucosal dissection for local resection of gastric tumors with appropriate, minimal surgical resection margins. The LECS concept was initially developed from the classical LECS procedure for gastric submucosal tumor resection. Many researchers reported that classical LECS was a safe and feasible technique for resection of gastric submucosal tumors, regardless of tumor location, including the esophagogastric junction. Recently, LECS was approved for insurance coverage by Japan's National Health Insurance plan and widely applied for gastric submucosal tumor resection. However, the limitations of classical LECS are the risk of abdominal infection, scattering of tumor cells in the abdominal cavity, and tumor cell seeding in the peritoneum. The development of modified LECS procedures, such as inverted‐LECS, non‐exposed endoscopic wall‐inversion surgery, a combination of laparoscopic and endoscopic approaches to neoplasia with a non‐exposure technique, and closed‐LECS, has almost resolved these drawbacks. This has led to a recent increase in the indicat