Abstract:
Objective
To compare the clinical value of preoperative evaluation of gastric cancer beyong the indications of endoscopic with simultaneous treatment using super minimally invasive surgery-Novel combined endoscopic and laparoscopic surgery （NCELS） and sequential endoscopic and laparoscopic treatment， and to optimize the treatment regimen of NCELS.
Method
47 cases of gastric cancer preoperatively evaluated as an indication beyond endoscopic treatment in the First Affiliated Hospital of Army Military Medical University between January 2018 and January 2024 were retrospectively counted，all of which were proposed to be treated with NCELS. There were 24 cases in the simultaneous treatment group and 23 cases in the sequential treatment group， analyzing and comparing the differences in preoperative and postoperative pathological diagnosis and treatment options between simultaneous and sequential treatment.
Results
24 patients in the simultaneous treatment group， of which 21 were diagnosed consistently with preoperative and postoperative beyond endoscopic indications for treatment， 3 were diagnosed postoperatively with endoscopic indications for treatment， and all 24 underwent lymph node dissection. There were 23 patients in the sequential treatment group， among which 7 cases with consistent diagnosis of preoperative and postoperative beyond endoscopic treatment indications supplemented lymph node dissection， and the remaining 16 cases with postoperative pathological diagnosis of endoscopic treatment indications did not undergo lymph node dissection. The factors of gastric cancer lesion size and differentiation degree have a greater influence on preoperative in-depth diagnosis. The operation time， hospitalization cost and complication occurrence in the sequential treatment group were lower than those in the simultaneous treatment group，and there was a significant difference in operation time and hospitalization cost （P ＜0. 01）.
Conclusion
The optimized NCELS endoscopic and sequential treatment is based on the pathology of the postoperative endoscopic resection specimen，which determines whether to supplement the lymph node dissection or not，and avoids surgical laparoscopic intervention in which the indications for preoperative beyond endoscopic treatment are over-judged，making the treatment more precise and minimally invasive.
Key words:
NCELS,
Indications beyond endoscopic,
Sequential treatment,
Super minimally invasive surgery
Jianhua Dai, Yusi Qin, Lei Chen, Zhihong Peng, Yao Chen, Li Liu, Hongbo Wu, Senlin Xu, Chuan Li, Feng Qian, Guiyong Peng. A super minimally invasive surgery option for preoperative evaluation of gastric cancer beyond the indication of endoscopic treatment：endoscopic and laparoscopic sequential tre[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2024, 11(04): 217-224.