| Theme |
New Developments in Laparoscopy and Endoscopy Cooperative Surgery (LECS) |
| Title |
Laparoscopy Endoscopy Cooperative Surgery (LECS) for Colorectal Tumors |
| Author |
Yoshiro Tamegai |
Endoscopy Division, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| Author |
Teruhito Kishihara |
Endoscopy Division, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| Author |
Yosuke Fukunaga |
Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| Author |
Akiko Chino |
Endoscopy Division, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| Author |
Yoshiya Fujimoto |
Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| Author |
Takashi Akiyoshi |
Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| Author |
Tsuyoshi Konishi |
Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| Author |
Masashi Ueno |
Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| Author |
Masahiro Igarashi |
Endoscopy Division, Cancer Institute Hospital, Japanese Foudation For Cancer Reaerch |
| [ Summary ] |
The usefulness of endoscopic submucosal dissection (ESD) for lesions with fibrosis is limited from the viewpoint of safety and curability. For this reason, we established the laparoscopy‒endoscopy cooperative surgery (LECS) procedure applied with the ESD technique to complete a safe one‒piece resection with adequate surgical margin. We performed ESD of 1,016 colorectal tumors in 993 patients (male‒to‒female ratio, 580 : 413; mean age, 65.7 years). In 245 cases, the tumors were accompanied by fibrosis. These cases were divided into three groups, namely colorectal tumors without fibrosis (type A), colorectal tumors with fibrosis due to benign causes (biopsy, recurrence after EMR, etc.; type B), and colorectal tumors with fibrosis due to cancer invasion in the SM layer (type C). The one‒piece resection rates were as follows : type A; 724/743 (97.4 %), type B‒1; 73/76 (96.1 %), B‒2 : 36/40 (90.0 %), B‒3 : 22/38 (57.9 %), type C‒1 : 42/42 (100 %), C‒2 : 15/16 (93.8 %), C‒3 : 13/26 (50 %). We experienced three cases (0.3 %) of perforation among the type B cases. In the type B‒3 cases accompanied by a severe degree fibrosis, one‒piece resection was more difficult owing to the risk of perforation. The limitation of the application of ESD in these lesions is thought to lie on its safety and curability. We established the LECS procedure in order to achieve a safe one‒piece resection with adequate surgical margin. Indications of the LECS procedure for colorectal tumors were thought to be as follows : intramucosal carcinoma and adenoma that are accompanied by wide and severe degree of fibrosis due to tumor recurrence after endoscopic and surgical resection (categories 3, 4, and 5‒1 : Vienna classification); submucosal tumors; intramucosal carcinoma；and adenoma involving the appendix or diverticle. We successfully performed one‒piece resection for 8 cases by using the LECS procedure, for which the application of endoscopic resection was considered limited because of the high risk of perforation. |