Laparoscopic and Endoscopic Cooperative Surgery for Gastric Cancer as an Alternative Treatment in Elderly Patients: A Prospective Observational Study.

Aim: Laparoscopic and endoscopic cooperative surgery (LECS) is a minimally invasive procedure that preserves gastric function and reduces complications. Although widely applied for gastrointestinal stromal tumors, its role in gastric cancer remains uncertain. We prospectively evaluated LECS as an alternative for elderly gastric cancer patients who declined conventional gastrectomy. Methods: This single-center prospective study enrolled 20 patients aged 75-89 years with gastric cancer ≤ 5 cm. All patients underwent Inverted-LECS using the Crown method. The primary endpoint was surgery-related morbidity (Clavien-Dindo ≥ III). Secondary endpoints were operative outcomes, margin status, quality of life (QOL), and survival. Results: Median age was 82 years, and 80% were cT1. No intraoperative complications or conversions occurred. Surgical morbidity ≥ Grade III was 0%. Delayed gastric emptying occurred in 25%, all Grade II. Resection margins were negative in 80%, including all pathologically early cancers. At 3 months, body weight and fat-free mass were preserved, physical function scores recovered to baseline, and mental function improved. Ninety-day mortality was 0%. With a median follow-up of 32 months, disease progression occurred in six patients, mainly with advanced disease or positive margins. One- and 3-year overall survival rates were 95% and 76.2%, and disease-specific survival 95% and 90%. Conclusions: LECS was technically safe and feasible for elderly gastric cancer patients ineligible for gastrectomy. However, because oncological curability cannot be assured in advanced gastric cancer or high-grade lymph node metastasis, careful selection and informed consent are essential. LECS may serve as a functional-preserving alternative to observation or palliative treatment.