腹腔镜与内镜联合手术（LECS）是胃肿瘤微创治疗的重要发展方向，随着前哨淋巴结导航技术的融入，早期胃癌功能保留手术迎来新的发展阶段。目前，LECS的适应证已从黏膜下肿瘤逐步拓展至早期胃癌，但在肿瘤学安全边界、前哨淋巴结假阴性风险、肿瘤大小阈值、东西方技术路径差异以及机器人双镜联合的临床定位等方面仍存在一定分歧。LECS本身是内镜科与外科协作的产物，其适应证选择需要内镜科、胃肠外科、病理科、影像科等共同评估。通过多学科综合治疗协作组（MDT）模式综合判断肿瘤特征与病人情况，选择最适宜的术式，可有效严格把握指征，避免过度治疗。对于机器人辅助LECS等新兴技术，更需要通过MDT严格筛选获益明确的复杂病例，避免盲目开展。

Laparoscopic and endoscopic cooperative surgery (LECS) represents an important direction in the minimally invasive treatment of gastric tumors. With the integration of sentinel lymph node navigation, function-preserving surgery for early gastric cancer has entered a new phase of development. Currently, the indications for LECS have gradually expanded from submucosal tumors to early gastric cancer. However, controversies remain regarding oncological safety margins, the false negative risk of sentinel lymph node biopsy, tumor size thresholds, differences in technical approaches between Eastern and Western practices, and the clinical role of robot assisted LECS. LECS is inherently a collaborative procedure between endoscopists and surgeons, and its appropriate application requires multidisciplinary assessment involving endoscopy, gastrointestinal surgery, pathology, and radiology. Through multidisciplinary team (MDT) approach that comprehensively evaluates tumor characteristics and patient conditions, the optimal surgical procedure can be selected, thereby ensuring strict adherence to indications and avoiding overtreatment. For emerging techniques such as robot-assisted LECS, it is even more essential to use MDT discussion to rigorously identify complex cases that are likely to benefit, so as to prevent indiscriminate adoption.