LECS Combined With LSNNS for Early Gastric Cancer (LENS Trial) (LENS)

September 28, 2026 updated by: Zhidong Gao, Peking University People's Hospital

A Prospective, Single-Arm Study of Laparoscopic and Endoscopic Cooperative Surgery (LECS) Combined With Laparoscopic Sentinel Node Navigation Surgery (LSNNS) for Early Gastric Cancer (LENS Trial)

Early gastric cancer (EGC) is traditionally treated with either endoscopic resection or standard laparoscopic gastrectomy with formal lymph node dissection. However, endoscopic resection cannot evaluate or treat regional lymph node metastasis, whereas standard surgery significantly impairs postoperative gastric physiological function and patient quality of life (QoL). The LENS trial is a prospective, single-arm clinical study designed to evaluate the feasibility, safety, and long-term efficacy of Laparoscopic and Endoscopic Cooperative Surgery (LECS) combined with Laparoscopic Sentinel Node Navigation Surgery (LSNNS) using Indocyanine Green (ICG) fluorescence tracing for patients with cT1N0M0 early gastric cancer. In this trial, eligible patients will undergo intraoperative sentinel lymph node (SN) biopsy guided by ICG. Patients with negative SN status will receive stomach-preserving surgery (primarily Non-exposed Endoscopic Wall-inversion Surgery, NEWS), while those with positive SN status will convert to standard laparoscopic gastrectomy. The primary goal is to confirm whether this combined procedure provides long-term oncological safety comparable to standard radical gastrectomy, while significantly improving postoperative gastric function, nutritional status, and quality of life.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Background and Rationale:

Gastric cancer remains a major global health burden, with East Asia bearing the highest incidence. While traditional radical gastrectomy achieves thorough oncological cure through extensive lymphadenectomy, the loss of stomach volume and normal anatomical structure often leads to post-gastrectomy syndromes, malnutrition, and dumping syndrome. Non-exposed Endoscopic Wall-inversion Surgery (NEWS) avoids stomach perforation and tumor seeding, while LSNNS via Indocyanine Green (ICG) mapping accurately identifies first-station drainage lymph nodes to rule out metastasis. Combining NEWS with LSNNS offers a promising minimally invasive strategy that balances oncological safety with optimal organ function preservation. Study Design and Flow:

This is a single-center, prospective, single-arm exploratory study targeting 40 patients with cT1N0M0 early gastric cancer (differentiated T1b > 3 cm or undifferentiated T1b diagnosed by preoperative magnifying endoscopy). Preoperative Baseline Assessment:

Enrolled patients will undergo comprehensive staging and baseline function evaluations, including chest-abdomen-pelvis CT, magnifying endoscopy with biopsy, laboratory nutritional markers (TP, ALB, PA), Electrogastrography (EGG), upper GI contrast study, and quality of life questionnaires (EORTC QLQ-C30 and STO22). Intraoperative Sentinel Node Navigation and Surgery:During surgery, 2 mL (5 mg) of ICG tracer will be injected around the tumor via endoscopic submucosal or laparoscopic subserosal routes. After a 20-minute waiting period, fluorescent sentinel lymph nodes will be navigated and harvested for intraoperative rapid frozen section pathological examination. Intraoperative Decision Path:SN Negative (SBN-): Patients receive stomach-preserving LECS (primarily NEWS) to achieve minimal resection with clear local margins. SN Positive (SBN+): Patients immediately convert to standard laparoscopic gastrectomy with formal D1/D1+ lymph node dissection. Postoperative Management and Rescue Protocol:

If postoperative formal paraffin pathology indicates unexpected lymph node metastasis in patients who underwent LECS, a multidisciplinary team (MDT) discussion will be initiated to decide on completion radical gastrectomy or adjuvant strategies. Follow-up Plan:

Patients will be systematically followed up at 3 months, 1 year, 3 years, and 5 years postoperatively. Evaluation parameters include 3-year and 5-year Disease-Free Survival (DFS), Overall Survival (OS), surgical complications (Clavien-Dindo classification), electrogastrography, nutritional indicators, and QoL scores.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
40

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • China
    • Beijing Municipality
      • Beijing, Beijing Municipality, China, 100044
        • Recruiting
        • Peking University People's Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

20 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

The study population consists of hospitalized patients or outpatient candidates diagnosed with cT1N0M0 early gastric adenocarcinoma at Peking University People's Hospital who are scheduled for laparoscopic surgical treatment and fulfill the study eligibility criteria.

Description

Inclusion Criteria:

  • Preoperative biopsy confirming solitary lesion of gastric adenocarcinoma
  • Preoperative magnifying endoscopy diagnosis of differentiated T1b (> 3 cm) or undifferentiated T1b
  • Scheduled to undergo laparoscopic surgery
  • Age between 20 and 80 years
  • ECOG performance status of 0 or 1
  • Signed written informed consent to participate in this clinical study

Exclusion Criteria:

  • Suitable for endoscopic treatment (e.g., standard ESD indications)
  • Unsuitable for surgery due to severe comorbidities (such as severe cardiopulmonary diseases)
  • Pregnant women
  • Known history of allergy to Indocyanine Green (ICG)
  • Prior history of upper abdominal surgery (except laparoscopic cholecystectomy)
  • Prior history of upper abdominal radiation therapy
  • Coexistence of other malignant tumors within the past 5 years

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: COHORT
  • Time Perspectives: PROSPECTIVE

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
LECS + LSNNS Group

Eligible early gastric cancer patients will undergo LSNNS with ICG fluorescence tracer. If sentinel lymph nodes are negative by intraoperative frozen pathology, patients receive LECS (e.g., NEWS). If positive, standard laparoscopic gastrectomy with lymphadenectomy will be performed.
Procedure: Procedure: LECS combined with LSNNS

Patients with cT1N0M0 early gastric cancer will undergo Laparoscopic and Endoscopic Cooperative Surgery (LECS) combined with Laparoscopic Sentinel Node Navigation Surgery (LSNNS).Sentinel Lymph Node Biopsy (LSNNS):

Indocyanine green will be injected submucosally via endoscopy or subserosally via laparoscopy around the tumor site. After a 20-minute tracer waiting period, fluorescent sentinel lymph nodes (SNs) will be navigated and harvested laparoscopically for intraoperative frozen section pathological evaluation. Surgical Procedure Based on SN Status:If intraoperative SN status is negative (SBN-): Patients will undergo stomach-preserving surgery using non-exposed LECS techniques, primarily Non-exposed Endoscopic Wall-inversion Surgery (NEWS). If intraoperative SN status is positive (SBN+): Patients will immediately convert to standard laparoscopic gastrectomy with formal D1/D1+ lymph node dissection.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
3-Year Disease-Free Survival (DFS)
Time Frame: 3 years post-operation

DFS is defined as the proportion of patients who survive without early gastric cancer recurrence (local, regional, or distant) or death from any cause at 3 years after surgery.
3 years post-operation

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Postoperative Complications
Time Frame: Within 30 days post-operation

The incidence and severity of postoperative complications will be evaluated and graded according to the Clavien-Dindo classification system (Grade I to Grade V), including bleeding, anastomotic/gastric wall leakage, gastroparesis, wound complications, and intra-abdominal infection. The percentage of participants experiencing at least one complication (Grade II or higher) will be reported.
Within 30 days post-operation
Patient-Reported Quality of Life (EORTC QLQ-C30)
Time Frame: Baseline (pre-operation), 3 months, 1 year, 3 years, and 5 years post-operation.

Evaluated using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Scores range from 0 to 100, where higher scores for functional scales represent higher/better levels of functioning, and higher scores for symptom scales represent a higher level of symptomatology.
Baseline (pre-operation), 3 months, 1 year, 3 years, and 5 years post-operation.
Gastric Cancer-Specific Quality of Life (STO22)
Time Frame: Baseline (pre-operation), 3 months, 1 year, 3 years, and 5 years post-operation.

Evaluated using the EORTC QLQ-STO22 module. Scores range from 0 to 100, with higher scores indicating worse gastric-specific symptoms (e.g., dysphagia, pain, reflux, eating restrictions).
Baseline (pre-operation), 3 months, 1 year, 3 years, and 5 years post-operation.
5-Year Disease-Free Survival (DFS) and Overall Survival (OS)
Time Frame: 5 years post-operation

5-year DFS is defined as the proportion of recurrence-free patients. 5-year OS is defined as the percentage of patients who are still alive at 5 years post-operation regardless of the cause of death.
5 years post-operation
Time to First Postoperative Bowel Flatus
Time Frame: From date of surgery up to postoperative Day 7

The time interval (in days) from the completion of surgery to the first passage of flatus, serving as a measure of early gastrointestinal functional recovery.
From date of surgery up to postoperative Day 7
Change in Body Mass Index (BMI)
Time Frame: Baseline (pre-operation), at hospital discharge (an average of 7 to 14 days post-operation), 3 months, 1 year, 3 years, and 5 years post-operation.

Body Mass Index (BMI) will be calculated as weight in kilograms divided by the square of height in meters (kg/m^2). The change from baseline to each post-operative follow-up time point will be evaluated to assess postoperative nutritional status.
Baseline (pre-operation), at hospital discharge (an average of 7 to 14 days post-operation), 3 months, 1 year, 3 years, and 5 years post-operation.
Length of Postoperative Hospital Stay
Time Frame: From date of surgery up to hospital discharge (assessed up to 30 days post-operation)

The duration from the day of surgery to hospital discharge, measured in days, to evaluate short-term postoperative recovery.
From date of surgery up to hospital discharge (assessed up to 30 days post-operation)
Postoperative 30-Day Mortality Rate
Time Frame: Within 30 days post-operation

Percentage of participants who die from any cause within 30 days following surgery.
Within 30 days post-operation

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Peking University People's Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
August 4, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 31, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 31, 2030

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 12, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 28, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 5, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 5, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 28, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • LENS-v1.1

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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