Current perspectives on combining endoscopy and minimally invasive surgery for upper gastrointestinal tumors

Recent advances in endoscopy have expanded the therapeutic spectrum of minimally invasive gastrointestinal surgery. Several modified procedures have been developed to reduce the risk of bacterial contamination and tumor cell dissemination associated with intentional perforation in classical laparoscopic and endoscopic cooperative surgery (LECS), including inverted LECS and non-exposed approaches. Long-term outcomes of these procedures for gastric lesions have recently been reported, supporting their favorable safety and efficacy. Moreover, the incorporation of sentinel lymph node navigation into non-exposed techniques represents a promising strategy for function-preserving gastric cancer surgery, and recent phase III trials have begun to evaluate its clinical value and long-term outcomes. Additionally, endoscopic full-thickness resection has recently been gaining wider acceptance in Japan and is facilitated by staged strategies that integrate endoscopic resection with single-port placement. Combined endoscopic procedures have been applied to the pharynx, esophagus, and duodenum with excellent short-term outcomes; nonetheless, long-term data remain limited. Ongoing innovations and multicenter studies may refine indications, standardize techniques, and validate safety and efficacy. Overall, the integration of endoscopy and surgery is likely to become increasingly critical in achieving both oncological curability and organ preservation in the management of gastrointestinal tumors.