Laparoscopic Intragastric Submucosal Dissection (LISD) for Early Gastric Cancer: An Organ-Preserving Alternative When ESD Is Not Feasible
Jose Luis Quezada, Felipe Farfán, Ignacio Obaid, Paula FluxáBackground:
Endoscopic submucosal dissection (ESD) is the standard organ-preserving treatment for selected patients with early gastric cancer (EGC). However, certain tumor locations, lesion size, technical complexity, or limited availability of advanced endoscopic expertise may render ESD unsuitable or unavailable. In these scenarios, formal gastric resection often becomes the conventional alternative despite its functional consequences. To describe the laparoscopic intragastric submucosal dissection (LISD) technique and report our initial South American experience using LISD as an organ-preserving surgical option in selected patients with EGC.
Methods:
A retrospective consecutive case series was conducted at 2 Chilean institutions between 2022 and 2024. Consecutive patients with EGC underwent LISD when ESD was considered technically unsuitable or unavailable. The procedure consisted of intragastric laparoscopic submucosal resection using transgastric trocar access. Outcomes included operative details, perioperative morbidity, pathologic findings, hospital stay, and oncologic follow-up.
Results:
Three male patients aged 65, 76, and 81 years underwent LISD. Indications included limited access to ESD resources in one case and technical limitations for curative ESD related to lesion size or location in 2 cases. En bloc resection was achieved in all patients without conversion to gastrectomy during the index procedure. Final pathology demonstrated well-to-moderately differentiated gastric adenocarcinoma in all cases, including one mucosal and 2 submucosal lesions. One patient underwent additional subtotal gastrectomy due to a positive lateral margin, with no residual tumor identified in the surgical specimen. No major postoperative morbidity or mortality occurred, and all patients were discharged on postoperative day 5. Maximum follow-up approached 3 years, with no tumor recurrence or procedure-related late complications identified to date.
Conclusions:
LISD appears to be a feasible organ-preserving alternative for selected patients with EGC when ESD is unsuitable or unavailable. LISD may represent a promising organ-preserving surgical option for selected patients when ESD is unsuitable or unavailable.