腹腔镜与内镜联合手术（LECS）已逐渐成为胃癌外科精准治疗中的重要术式，其通过术中胃镜与腹腔镜的协同配合，为复杂胃癌微创手术提供了可靠技术手段，可有效提高术中切缘判定精度，改善肿瘤边界模糊等临床问题。食管胃结合部腺癌因解剖位置特殊、淋巴引流路径复杂，手术切缘阳性风险较高，对术中精准定位与切缘把控提出了更高要求。建议以近切缘 3 cm、远切缘 4 cm 作为切缘管理标准，以最大限度避免切缘阳性。通过构建“术前钛夹标记定位-术中双镜协同确认-美蓝标记切缘-腹腔镜专用棒尺精准测量”的标准化操作模式，为胃癌微创手术的精准实施与安全保障提供可借鉴的技术路径与规范化操作思路。然而，LECS 临床应用仍面临诸多技术难点，通过建立标准化操作规范、培养外科医师自主完成内镜操作、针对高危病理类型适当放宽安全切缘距离并加强术中病理筛查，可有效应对上述难点。目前，LECS用于胃癌术中肿瘤定位与切缘判定的临床研究仍相对有限，且多为单中心或回顾性研究，未来需开展更多大型、多中心、前瞻性研究，以提供更高等级的循证医学证据。

Laparoscopic-endoscopic cooperative surgery (LECS) has gradually emerged as an important surgical modality in the precise surgical management of gastric cancer. Through the intraoperative synergy of gastroscopy and laparoscopy, LECS provides a reliable technical solution for minimally invasive surgery of complex gastric cancer, effectively enhancing the accuracy of intraoperative margin assessment and addressing clinical challenges such as ambiguous tumor boundaries. Adenocarcinoma of the esophagogastric junction, due to its unique anatomical location and complex lymphatic drainage pathways, carries a relatively high risk of positive surgical margins, thereby imposing more stringent requirements on intraoperative precise localization and margin control. A standard of 3 cm for the proximal resection margin and 4 cm for the distal resection margin is recommended as standards for intraoperative margin management to minimize the incidence of positive margins. A standardized operational workflow comprising “preoperative titanium clip marking and localization - intraoperative dual-scope collaborative confirmation - methylene blue margin marking - precise measurement with a dedicated laparoscopic rod ruler” provides a referable technical pathway and standardized operational framework for the precise implementation and safety assurance of minimally invasive gastric cancer surgery. Nevertheless, the clinical application of LECS still encounters numerous technical difficulties. These challenges can be effectively addressed through the establishment of standardized operational protocols, training surgeons to independently perform endoscopic procedures, appropriately extending the safe margin distance for high-risk pathological types, and reinforcing intraoperative frozen pathological screening. Currently, clinical research on the application of dual-scope combined technology for intraoperative tumor localization and margin assessment in gastric cancer remains relatively scarce, with most studies being single-center or retrospective in design. Future endeavors should focus on conducting more large-scale, multicenter, prospective studies to provide higher-level evidence-based medical evidence.