Objective:

To evaluate the long-term outcomes of patients who underwent non-exposure LECS (CLEAN-NET) for gastric cancer during its early developmental phase.

Approach:

• Study Design: Retrospective study of consecutive patients who underwent non-exposure LECS (CLEAN-NET) for gastric cancer between December 2008 and June 2010.
• Surgical Procedure: CLEAN-NET involved laparoscopic full-thickness resection without opening the gastric lumen, with limited regional lymph node dissection based on intraoperative lymphatic drainage.
• Pathological Evaluation: Resected specimens were evaluated for tumor characteristics and classified according to the Japanese Classification of Gastric Carcinoma.
• Follow-Up: Patients were followed with clinical examinations, endoscopic surveillance, and imaging studies to assess recurrence and overall survival.

Key Findings:

• CLEAN-NET allows for function-preserving resection of early-stage gastric cancer.
• Long-term outcomes were evaluated with follow-up extending up to 16.8 years.
• The study provides ultra-long-term observational data on the clinical course after this approach.

Interpretation:

Robust long-term oncologic validation of LECS-type local resection for gastric cancer remains lacking, particularly beyond 10 years.

Limitations:

• The study is retrospective and may have selection bias.
• Limited sample size and lack of standardized D2 lymphadenectomy.

Conclusion:

Further studies are needed for comprehensive long-term validation of CLEAN-NET for early-stage gastric cancer.