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

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.

• References

• 1 Hiki N, Yamamoto Y, Fukunaga Y. et al. Laparoscopic endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008; 22: 1729-1735
• 2 Fukunaga Y, Tamegai Y, Chino A. et al. New technique of en bloc resection of colorectal tumor using laparoscopy and endoscopy cooperatively (laparoscopy and endoscopy cooperative surgery - colorectal). Dis Colon Rectum 2014; 57: 267-271
• 3 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complication: five-year experience. ANN Surg 2009; 250: 187-96
• 4 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (Suppl. 06) S3-43
• 5 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
• 6 Tamegai Y, Saito Y, Masaki N. et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 2007; 39: 418-422
• 7 Hayashi N, Tanaka S, Nishiyama S. et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc 2014; 79: 427-435
• 8 Imai K, Hotta K, Yamaguchi Y. et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc 2016; 83: 954-962
• 9 Iacopini F, Saito Y, Belle A. et al. Colorectal endoscopic submucosal dissection: predictors and neoplasm-related gradients of difficulty. Endoscopy Int Open 2017; 05: E839-E846
• 10 Prohm P, Weber J, Bonner C. Laparoscopic-assisted coloscopic polypectomy. Dis Colon Rectum 2001; 44: 746-748
• 11 Ommer A, Limmer J, Möllenberg H. et al. Laparoscopic-assisted colonoscopic polypectomy – indications and results [in German]. Zentralbl Chir 2003; 128: 195-198
• 12 Feussner H, Wilhelm D, Dotzel V. et al. Combined Endoluminal and Endocavitary Approaches to Colonic Lesions. Surg Technol Int 2003; 11: 97-101
• 13 Winter H, Lang RA, Spelsberg FW. et al. Laparoscopic colonoscopic rendezvous procedures for the treatment of polyps and early stage carcinomas of the colon. Int J Colorectal Dis 2007; 22: 1,377-1,381
• 14 Franklin ME Jr, Portillo G. Laparoscopic monitored colonoscopic polypectomy:long-term follow-up. World J Surg 2009; 33: 1,306-1,309
• 15 Wilhelm D, Delius S, Weber L. et al. Combined laparoscopic-endoscopic resection of colorectal polyps: 10-year experience and follow-up. Surg Endosc 2009; 23: 688-693
• 16 Agrawal D, Chak A, Champagne BJ. et al. Endoscopic mucosal resection with full-thickness closure for difficult polyps: a prospective clinical trial. Gastrointest Endosc 2010; 71: 1082-1088
• 17 Cruz RA, Ragupathi M, Pedraza R. et al. Minimally invasive approaches for the management of “difficult” colonic polyps. Diagn Ther Endosc 2011; DOI: 10.1155/2011/682793.
• 18 Yan J, Trencheva K, Lee SW. et al. Treatment for right colon polyps not removabC, Burke JP, le using standard colonoscopy: combined laparoscopic-colonoscopic approach. Dis Colon Rectum 2011; 54: 753-758
• 19 Wood JJ, Lord AC, Wheeler JM. et al. Laparoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure. Ann R Coll Surg Engl 2011; 93: 241-245
• 20 Gtrunhagen DJ, van Ierland MC, Doornebosch PG. et al. Laparoscopic-monitored colonioc polypectomy: a multimodality method to avoid segmental colon resection. Colorecta Dis 2011; 13: 1280-1284
• 21 Lee SW, Garrett MK, Shin JH. et al. Dynamic Article: Long-term outcomes of patients undergoing combined endolaparoscopic surgery for benign colon polyps. Dis Colon Rectum 2013; 56: 869-873
• 22 Goh C, Burke JP, MaNamara DA. et al. Endolaparoscopic removal of colonic polyps. Colorectal Dis 2014; 16: 271-275
• 23 Nakajima T, Saito Y, Tanaka S. et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endos 2013; 27: 3262-70
• 24 Oka S, Tanaka S, Saito Y. et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 2015; 110: 697-707
• 25 Schmidt A, Bauerfeind P, Gubuler C. et al. Endoscopic full-thickness resection in the colorectum with a novel over-the scope device: first experience. Endoscopy 2015; 47: 719-725
• 26 Richter-Schrag HJ, Walker C, Thimme R. et al. Full thickness resection device (FTRD): Experience and outcome for benign neoplasms of the rectum and colon]. Chirurg 2016; 87: 316-325
• 27 Andrisani G, Pizzicannella M, Martino M. et al. Endoscopic full-thickness resection of superficial colorectal neoplasms using a new over-the-scope clip system: A single-centre study. Digest Liver Dis 2017; 49: 1009-1013
• 28 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the scope device: a prospective multicenter study in various incications. Gut 2017; DOI: 10.1136/gutjnl-2016-313677.
• 29 Valli PV, Mertens J, Bauerfeind P. Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD). Surg Endosc 2018; 32: 289-299
• 30 Nunobe S, Hiki N, Gotoda T. et al. Successful application of laparoscopic and endoscopic cooperative surgery (LECS) for a lateral-spreading mucosal gastric cancer. Gastric Cancer 2012; 15: 338-342