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Cancers
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New Technologies and Advancements in Gastro-Esophageal Cancer Surgery
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New Technologies and Advancements in Gastro-Esophageal Cancer Surgery

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 23378

Special Issue Editors

Prof. Dr. Daniel Reim

E-Mail Website
Guest Editor
TUM School of Medicine, Department of Surgery, Technical University Munich, 21-80333 Munich, Germany
Interests: minimally invasive gastroesophageal cancer surgery
Prof. Dr. Alexander Novotny

E-Mail Website
Guest Editor
TUM School of Medicine, Department of Surgery, Technical University Munich, Munich, Germany
Interests: Minimal invasive gastroesophageal cancer surgery
Dr. Rebekka Schirren

E-Mail Website
Guest Editor
TUM School of Medicine, Department of Surgery, Technical University Munich, Munich, Germany
Interests: Minimal invasive gastroesophageal cancer surgery

Special Issue Information

Dear Colleagues,

In addition to multimodal treatments for gastroesophageal cancer, surgical advancements in the field of minimal invasive procedures have developed rapidly over the past few years. Since the first laparoscopic gastrectomy performed in 1991 in Japan, technical advancements have led to a wider applicability of this technology in even advanced cancer cases. However, the added value of these procedures in upper GI cancer surgery was not yet defined in the most rigorous scientific manner. Still, there are many disparities between the Eastern (especially China, Japan and Korea) and the Western worlds.

In this Special Issue of Cancers, up-to-date original research, short communications, and comprehensive review articles on all technologies playing a role in the treatment of upper gastrointestinal malignancies with a special focus on short and long-term outcomes are eligible for publication. Not only surgical innovations but also technical innovations in the perioperative care setting, diagnostics, and translational setting, as well as the results of preclinical studies with implications on treatment, will qualify for publication.

Dr. Daniel Reim
Prof. Dr. Alexander Novotny
Dr. Rebekka Schirren
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastric cancer
  • esophageal cancer
  • GE-junction cancer
  • minimally invasive surgery (robotic, laparoscopic)
  • new technologies in upper GI intestinal cancer surgery

Published Papers (9 papers)

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Research

16 pages, 2208 KiB  
Article
UICC Staging after Neoadjuvant/Perioperative Chemotherapy Reveals No Significant Survival Differences Compared to Primary Surgery for Locally Advanced Gastric Cancer
by Rebekka Dimpel, Alexander Novotny, Julia Slotta-Huspenina, Rupert Langer, Helmut Friess and Daniel Reim
Cancers 2022, 14(24), 6169; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14246169 - 14 Dec 2022
Viewed by 1163
Abstract
Background: The applicability of UICC TNM staging for gastric cancer (GC) patients treated with neoadjuvant chemotherapy (nCTX) and surgery was not yet analyzed in comparison to patients undergoing primary surgery (PS). The purpose of this analysis was to analyze if the prognostic impact [...] Read more.
Background: The applicability of UICC TNM staging for gastric cancer (GC) patients treated with neoadjuvant chemotherapy (nCTX) and surgery was not yet analyzed in comparison to patients undergoing primary surgery (PS). The purpose of this analysis was to analyze if the prognostic impact of TNM staging after nCTx is comparable with PS. Methods: Data for patients having been treated for GC with or without nCTx between 1990 and 2016 were analyzed. Uni-(URA) and multivariable regression analyses (MRA) were performed to identify predictors. Survival according to the UICC 8th edition stages was analyzed by the Kaplan–Meier method and cox regression analysis. Propensity score matching (PSM) was performed to balance for confounders. Results: 1149 patients with GC were eligible for primary analysis. URA demonstrated age (p < 0.0001), tumor localization (p < 0.0001), clinical UICC-stage, complications, UICC stage 0, IIB-IIIC, Lauren subtype, grading, and R-stage to be significantly associated with OS. MRA revealed that age, distal tumor localization, more than 25 dissected lymph nodes, UICC stage 0, IIB-IIIC, and Lauren subtype were significantly and independently related to OS. After PSM, survival analyses revealed only a significant difference for pN2/ypN2 (p = 0.03), while all other T and N stages were comparable. Conclusion: UICC dependent survival stages do not change significantly after nCTx treatment for GC. Therefore, UICC staging in its present version is applicable to patients undergoing nCTx. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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9 pages, 547 KiB  
Article
Spade-Shaped Anastomosis after Laparoscopic Proximal Gastrectomy Using Double Suture Anchoring between the Posterior Wall of the Esophagus and the Anterior Wall of the Stomach (SPADE Operation): A Case Series
by Sin Hye Park, Harbi Khalayleh, Sung Gon Kim, Sang Soo Eom, Fahed Merei, Junsun Ryu and Young-Woo Kim
Cancers 2022, 14(2), 379; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14020379 - 13 Jan 2022
Cited by 3 | Viewed by 2417
Abstract
We introduced SPADE operation, a novel anastomotic method after laparoscopic proximal gastrectomy (PG). Technical modifications were performed and settled. This report aimed to demonstrate the short-term clinical outcomes after settlement. Data from 34 consecutive patients who underwent laparoscopic PG with SPADE between June [...] Read more.
We introduced SPADE operation, a novel anastomotic method after laparoscopic proximal gastrectomy (PG). Technical modifications were performed and settled. This report aimed to demonstrate the short-term clinical outcomes after settlement. Data from 34 consecutive patients who underwent laparoscopic PG with SPADE between June 2017 and March 2020 were retrospectively reviewed. Reflux was evaluated based on the patients’ symptoms and follow-up endoscopy using Los Angeles (LA) classification and RGB Classification (Residue, Gastritis, Bile). Other complications were classified using the Clavien–Dindo method. The incidence of reflux esophagitis was 2.9% (1/34). Bile reflux was observed in six patients (17.6%), and residual food was observed in 16 patients (47.1%) in the endoscopy. Twenty-eight patients had no reflux symptoms (82.4%), while five patients (14.7%) and one patient (2.9%) had mild and moderate reflux symptoms, respectively. The rates of anastomotic stricture and ileus were 14.7% (5/34) and 11.8% (4/34), respectively. No anastomotic leakage was observed. The incidence of major complications (Clavien-Dindo grade III or higher) was 14.7%. The SPADE operation following laparoscopic PG is effective in reducing gastroesophageal reflux. Its clinical usefulness should be validated using prospective clinical trials. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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15 pages, 2684 KiB  
Article
Single Snapshot Imaging of Optical Properties (SSOP) for Perfusion Assessment during Gastric Conduit Creation for Esophagectomy: An Experimental Study on Pigs
by Lorenzo Cinelli, Eric Felli, Luca Baratelli, Silvère Ségaud, Andrea Baiocchini, Nariaki Okamoto, María Rita Rodríguez-Luna, Ugo Elmore, Riccardo Rosati, Stefano Partelli, Jacques Marescaux, Sylvain Gioux and Michele Diana
Cancers 2021, 13(23), 6079; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13236079 - 02 Dec 2021
Cited by 3 | Viewed by 1807
Abstract
Anastomotic leakage (AL) is a serious complication occurring after esophagectomy. The current knowledge suggests that inadequate intraoperative perfusion in the anastomotic site contributes to an increase in the AL rate. Presently, clinical estimation undertaken by surgeons is not accurate and new technology is [...] Read more.
Anastomotic leakage (AL) is a serious complication occurring after esophagectomy. The current knowledge suggests that inadequate intraoperative perfusion in the anastomotic site contributes to an increase in the AL rate. Presently, clinical estimation undertaken by surgeons is not accurate and new technology is necessary to improve the intraoperative assessment of tissue oxygenation. In the present study, we demonstrate the application of a novel optical technology, namely Single Snapshot imaging of Optical Properties (SSOP), used to quantify StO2% in an open surgery experimental gastric conduit (GC) model. After the creation of a gastric conduit, local StO2% was measured with a preclinical SSOP system for 60 min in the antrum (ROI-A), corpus (ROI-C), and fundus (ROI-F). The removed region (ROI-R) acted as ischemic control. ROI-R had statistically significant lower StO2% when compared to all other ROIs at T15, T30, T45, and T60 (p < 0.0001). Local capillary lactates (LCLs) and StO2% correlation was statistically significant (R = −0.8439, 95% CI −0.9367 to −0.6407, p < 0.0001). Finally, SSOP could discriminate resected from perfused regions and ROI-A from ROI-F (the future anastomotic site). In conclusion, SSOP could well be a suitable technology to assess intraoperative perfusion of GC, providing consistent StO2% quantification and ROIs discrimination. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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12 pages, 2301 KiB  
Article
Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System
by Sejin Lee, Jeong Ho Song, Sung Hyun Park, Minah Cho, Yoo Min Kim, Hyoung-Il Kim and Woo Jin Hyung
Cancers 2021, 13(22), 5768; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13225768 - 17 Nov 2021
Cited by 3 | Viewed by 1779
Abstract
Background: Additional surgery after non-curative endoscopic submucosal dissection (ESD) may be excessive as few patients have lymph node metastasis (LNM). It is necessary to develop a risk stratification system for LNM after non-curative ESD, such as the eCura system, which was introduced in [...] Read more.
Background: Additional surgery after non-curative endoscopic submucosal dissection (ESD) may be excessive as few patients have lymph node metastasis (LNM). It is necessary to develop a risk stratification system for LNM after non-curative ESD, such as the eCura system, which was introduced in the Japanese gastric cancer treatment guidelines. However, the eCura system requires venous and lymphatic invasion to be separately assessed, which is difficult to distinguish without special immunostaining. In this study, we practically modified the eCura system by classifying lymphatic and venous invasion as lymphovascular invasion (LVI). Method: We retrospectively reviewed 543 gastric cancer patients who underwent radical gastrectomy after non-curative ESD between 2006 and 2019. LNM was evaluated according to LVI as well as size >30 mm, submucosal invasion ≥500 µm, and vertical margin involvement, which were used in the eCura system. Results: LNM was present in 8.1% of patients; 3.6%, 2.3%, 7.4%, 18.3%, and 61.5% of patients with no, one, two, three, and four risk factors had LNM, respectively. The LNM rate in the patients with no risk factors (3.6%) was not significantly different from that in patients with one risk factor (2.3%, p = 0.523). Among patients with two risk factors, the LNM rate without LVI was significantly lower than with LVI (2.4% vs. 10.7%, p = 0.027). Among patients with three risk factors, the LNM rate without LVI was lower than with LVI (0% vs. 20.8%, p = 0.195), although not statistically significantly. Based on LNM rates according to risk factors, patients with LVI and other factors were assigned to the high-risk group (LNM, 17.4%) while other patients as a low-risk group (LNM, 2.4%). Conclusions: Modifying the eCura system by classifying lymphatic and venous invasion as LVI successfully stratified LNM risk after non-curative ESD. Moreover, the high-risk group can be simply identified based on LVI and the presence of other risk factors. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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20 pages, 1989 KiB  
Article
Laparoscopic Compared with Open D2 Gastrectomy on Perioperative and Long-Term, Stage-Stratified Oncological Outcomes for Gastric Cancer: A Propensity Score-Matched Analysis of the IMIGASTRIC Database
by Stefano Trastulli, Jacopo Desiderio, Jian-Xian Lin, Daniel Reim, Chao-Hui Zheng, Felice Borghi, Fabio Cianchi, Enrique Norero, Ninh T. Nguyen, Feng Qi, Andrea Coratti, Maurizio Cesari, Francesca Bazzocchi, Orhan Alimoglu, Steven T. Brower, Graziano Pernazza, Simone D’Imporzano, Juan-Santiago Azagra, Yan-Bing Zhou, Shou-Gen Cao, Eleonora Garofoli, Claudia Mosillo, Francesco Guerra, Tong Liu, Giacomo Arcuri, Paulina González, Fabio Staderini, Alessandra Marano, Irene Terrenato, Vito D’Andrea, Sergio Bracarda, Chang-Ming Huang and Amilcare Parisiadd Show full author list remove Hide full author list
Cancers 2021, 13(18), 4526; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13184526 - 08 Sep 2021
Cited by 6 | Viewed by 2083
Abstract
Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted worldwide. However, studies focusing specifically on laparoscopic gastrectomy with D2 lymphadenectomy are still lacking in the literature. This retrospective study aimed to compare the short-term and long-term outcomes of laparoscopic versus [...] Read more.
Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted worldwide. However, studies focusing specifically on laparoscopic gastrectomy with D2 lymphadenectomy are still lacking in the literature. This retrospective study aimed to compare the short-term and long-term outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy for gastric cancer. Methods: The protocol-based, international IMIGASTRIC (International study group on Minimally Invasive surgery for Gastric Cancer) registry was queried to retrieve data on patients undergoing laparoscopic or open gastrectomy with D2 lymphadenectomy for gastric cancer with curative intent from January 2000 to December 2014. Eleven predefined, demographical, clinical, and pathological variables were used to conduct a 1:1 propensity score matching (PSM) analysis to investigate intraoperative and recovery outcomes, complications, pathological findings, and survival data between the two groups. Predictive factors of long-term survival were also assessed. Results: A total of 3033 patients from 14 participating institutions were selected from the IMIGASTRIC database. After 1:1 PSM, a total of 1248 patients, 624 in the laparoscopic group and 624 in the open group, were matched and included in the final analysis. The total operative time (median 180 versus 240 min, p < 0.0001) and the length of the postoperative hospital stay (median 10 versus 14.8 days, p < 0.0001) were longer in the open group than in the laparoscopic group. The conversion to open rate was 1.9%. The proportion of patients with in-hospital complications was higher in the open group (21.3% versus 15.1%, p = 0.004). The median number of harvested lymph nodes was higher in the laparoscopic approach (median 32 versus 28, p < 0.0001), and the proportion of positive resection margins was higher (p = 0.021) in the open group (5.9%) than in the laparoscopic group (3.2%). There was no significant difference between the groups in five-year overall survival rates (77.4% laparoscopic versus 75.2% open, p = 0.229). Conclusion: The adoption of the laparoscopic approach for gastric resection with D2 lymphadenectomy shortened the length of hospital stay and reduced postoperative complications with respect to the open approach. The five-year overall survival rate after laparoscopy was comparable to that for patients who underwent open D2 resection. The types of surgical approaches are not independent predictive factors for five-year overall survival. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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22 pages, 22743 KiB  
Article
Minimally Invasive Approach to Gastric GISTs: Analysis of a Multicenter Robotic and Laparoscopic Experience with Literature Review
by Graziano Ceccarelli, Gianluca Costa, Michele De Rosa, Massimo Codacci Pisanelli, Barbara Frezza, Marco De Prizio, Ilaria Bravi, Andrea Scacchi, Gaetano Gallo, Bruno Amato, Walter Bugiantella, Piergiorgio Tacchi, Alberto Bartoli, Alberto Patriti, Micaela Cappuccio, Klara Komici, Lorenzo Mariani, Pasquale Avella and Aldo Rocca
Cancers 2021, 13(17), 4351; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13174351 - 27 Aug 2021
Cited by 17 | Viewed by 7018
Abstract
Background: Gastrointestinal stromal tumors (GISTs) are most frequently located in the stomach. In the setting of a multidisciplinary approach, surgery represents the best therapeutic option, consisting mainly in a wedge gastric resection. (1) Materials and methods: Between January 2010 to September 2020, [...] Read more.
Background: Gastrointestinal stromal tumors (GISTs) are most frequently located in the stomach. In the setting of a multidisciplinary approach, surgery represents the best therapeutic option, consisting mainly in a wedge gastric resection. (1) Materials and methods: Between January 2010 to September 2020, 105 patients with a primary gastrointestinal stromal tumor (GISTs) located in the stomach, underwent surgery at three surgical units. (2) Results: A multi-institutional analysis of minimally invasive series including 81 cases (36 laparoscopic and 45 robotic) from 3 referral centers was performed. Males were 35 (43.2%), the average age was 66.64 years old. ASA score ≥3 was 6 (13.3%) in the RS and 4 (11.1%) in the LS and the average tumor size was 4.4 cm. Most of the procedures were wedge resections (N = 76; 93.8%) and the main operative time was 151 min in the RS and 97 min in the LS. Conversion was necessary in five cases (6.2%). (3) Conclusions: Minimal invasive approaches for gastric GISTs performed in selected patients and experienced centers are safe. A robotic approach represents a useful option, especially for GISTs that are more than 5 cm, even located in unfavorable places. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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10 pages, 1148 KiB  
Article
Effectiveness of a Novel Covered Stent without External Thread Fixation for Anastomotic Leakage after Total or Proximal Gastrectomy for Gastric Cancer
by Young-Il Kim, Chan Gyoo Kim, Jong Yeul Lee, Il Ju Choi, Bang Wool Eom, Hong Man Yoon, Keun Won Ryu and Young-Woo Kim
Cancers 2021, 13(15), 3720; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13153720 - 23 Jul 2021
Cited by 4 | Viewed by 1536
Abstract
A thread-fix stent entails long hospitalization and patient discomfort. We aimed to evaluate the efficacy of a novel stent with silicone-covered outer double layers without external fixation (Beta stent) for anastomotic leakage after total or proximal gastrectomy. The outcomes were compared between gastric [...] Read more.
A thread-fix stent entails long hospitalization and patient discomfort. We aimed to evaluate the efficacy of a novel stent with silicone-covered outer double layers without external fixation (Beta stent) for anastomotic leakage after total or proximal gastrectomy. The outcomes were compared between gastric cancer patients who underwent stent placement using a thread-fix stent between 2014 and 2015 (Thread-Fix Group) and those who received a Beta stent in the succeeding period until October 2018 (Beta Stent Group). The Beta Stent Group (n = 14) had a significantly higher leakage healing rate by the first stent placement (92.9% vs. 53.8%; p = 0.021) and had a shorter hospitalization period (median: 16 days vs. 28 days; p = 0.037) than the Thread-Fix Group (n = 13). Further, 50% of the Beta stent patients received outpatient management until stent removal. Stent maintenance duration was significantly longer in the Beta Stent Group (median, 28 days vs. 18 days; p = 0.006). There was no significant between-group difference in stent-related complications except for stent migration (7.1% (Beta Stent Group) vs. 0% (Thread-Fix Group), p = 0.326). In conclusion, the Niti-S Beta stent is an effective treatment for anastomotic leakage from total or proximal gastrectomy for gastric cancer. Stent maintenance is possible without hospitalization. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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12 pages, 1535 KiB  
Article
Ultrastaging Using Ex Vivo Sentinel Lymph Node Mapping and One-Step Nucleic Acid Amplification (OSNA) in Gastric Cancer: Experiences of a European Center
by Bruno Märkl, Bianca Grosser, Kerstin Bauer, Dmytro Vlasenko, Gerhard Schenkirsch, Andreas Probst and Bernadette Kriening
Cancers 2021, 13(11), 2683; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13112683 - 29 May 2021
Cited by 3 | Viewed by 2608
Abstract
Background: In this study, the effectiveness of One-step nucleic acid amplification (OSNA) in combination with ex vivo SLN mapping is compared with conventional histology including immunohistochemistry. Methods: LNs were retrieved from gastrectomy specimens in an unfixed state. After ex vivo SLN mapping using [...] Read more.
Background: In this study, the effectiveness of One-step nucleic acid amplification (OSNA) in combination with ex vivo SLN mapping is compared with conventional histology including immunohistochemistry. Methods: LNs were retrieved from gastrectomy specimens in an unfixed state. After ex vivo SLN mapping using methylene-blue, LNs were sliced to provide samples for histology and OSNA. Results: In total, 334 LNs were retrieved in the fresh state from 41 patients. SLN detection was intended in 40 cases but was successful in only 29, with a correct LN status prediction in 23 cases (79%). Excluding one case out of 41 with a failure likely caused by a processing error, OSNA showed a high effectiveness with sensitivity, specificity, and accuracy rates of 85.4%, 93.5%, and 92.4%, respectively. The LN status could be predicted in all but one case, in which the single positive LN was not eligible for OSNA testing. Moreover, OSNA evaluation led to upstaging from N0 to N+ in three cases (14%). Conclusion: The ex vivo SLN protocol used resulted in a relatively poor detection rate. However, the OSNA method was not hampered by this detection rate and proved its potential to increase the sensitivity of metastases detection. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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10 pages, 1560 KiB  
Article
Feasibility of Non-Exposure Simple Suturing Endoscopic Full-Thickness Resection in Comparison with Laparoscopic Endoscopic Cooperative Surgery for Gastric Subepithelial Tumors: Results of Two Independent Prospective Trials
by Bang Wool Eom, Chan Gyoo Kim, Myeong-Cherl Kook, Hong Man Yoon, Keun Won Ryu, Young-Woo Kim, Ji Yoon Rho, Young-Il Kim, Jong Yeul Lee and Il Ju Choi
Cancers 2021, 13(8), 1858; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13081858 - 13 Apr 2021
Cited by 9 | Viewed by 1569
Abstract
Recently, nonexposure simple suturing endoscopic full-thickness resection (NESS-EFTR) method was developed to avoid tumor exposure to the peritoneal cavity. The aim of this study is to compare the short-term outcomes of the NESS-EFTR method with those of laparoscopic and endoscopic cooperative surgery (LECS) [...] Read more.
Recently, nonexposure simple suturing endoscopic full-thickness resection (NESS-EFTR) method was developed to avoid tumor exposure to the peritoneal cavity. The aim of this study is to compare the short-term outcomes of the NESS-EFTR method with those of laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumors (SETs). A prospective single-center trial of LECS for gastric SETs was performed from March 2012 to October 2013 with a separate prospective trial of NESS-EFTR performed from August 2015 to June 2017, enrolling 15 patients each. Among the 30 enrolled patients, 14 who underwent LECS and 11 who underwent NESS-EFTR were finally included in the analysis. The rate of complete resection and successful closure was 100% in both groups. The operating time was longer for NESS-EFTR group than for LECS (110 vs. 189 min; p < 0.0001). There were no postoperative complications except one case of transient fever in the NESS-EFTR group. One patient in the LECS group had peritoneal seeding of gastrointestinal stromal tumor at 17 months postoperatively, and there was no other recurrence. Although NESS-EFTR had long operating and procedure times, it was feasible for patients with gastric SETs requiring a nonexposure technique. Full article
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
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