Comparative Assessment of Laparoscopic and Endoscopic Cooperative Surgery With Laparoscopic Wedge Resection for the Treatment of Gastric Submucosal Tumors

Background The most commonly performed surgical resection technique for gastric submucosal tumors (gSMTs) is laparoscopic wedge resection (LWR). Notably, laparoscopic and endoscopic cooperative surgery (LECS) is a surgical procedure that combines laparoscopic gastric resection with an endoscopic submucosal dissection for the local resection of gastric tumors, which provides appropriate and minimal surgical resection margins. Methods Seventy-nine patients with gSMT who underwent surgical resection at our department between January 2004 and January 2023 were retrospectively assessed. LWR and LECS were performed in 61 and 18 patients, respectively. Clinicopathological features and short-term surgical outcomes were assessed between the 2 groups. A 2:1 propensity score matching was performed to mitigate the effects of selection biases. Regardless of the surgical procedure, all the patients underwent curative resection with negative margins. Results The LWR and LECS groups included 24 and 12 patients, respectively. The mean operative duration was significantly shorter in the LWR group than in the LECS group (LWR, 131.1 minutes; LECS, 195.2 minutes; P 0.05). The mean ratio of tumor diameter to resected specimen diameter was significantly higher in the LECS group than in the LWR group (LWR, 60.3%; LECS, 78.9%; P 0.05). The mean ratio of tumor area to resected specimen area was significantly higher in the LECS group than in the LWR group (LWR, 44.7%; LECS, 66.3%; P 0.05). Conclusion LECS was performed safely with a minimal and optimal safety margin compared with LWR. The findings suggest that LECS can be a feasible option for the treatment of gSMTs.