胃癌外科治疗正逐步进入“兼顾根治性与功能保留”的新时代。这一理念的演进推动了双镜联合手术（LECS）在Ⅱ期胃癌诊治中的探索与应用。针对传统术式潜在的腹腔微转移风险，LECS逐渐向非暴露式改良术式演进，以严格遵循无瘤原则，有效降低肿瘤细胞脱落导致的腹腔种植风险。在精准化实施方面，内镜与腹腔镜的协同配合不仅能精准定位肿瘤边界以确保切缘阴性，更为安全实施胃保功能手术提供了技术保障，并在消化道重建时提供直视下的视野辅助，有助于降低并发症发生率。在肿瘤学安全性上，规范的腹腔镜操作能够保障D2淋巴结清扫的彻底性，而非暴露物理闭合机制则有效阻断了癌细胞的播散途径。但目前LECS仍面临远期生存高级别循证证据匮乏、术前影像学分期不确定性以及跨学科协作学习曲线陡峭等现实挑战。未来，依托机器人技术、吲哚菁绿（ICG）荧光导航以及多学科协作标准化流程，LECS将加速迈向精准化与个体化，进一步丰富和优化胃癌外科的治疗策略。

The surgical management of gastric cancer is steadily advancing into a new era characterized by a dual focus on oncological radicality and functional preservation. This paradigm shift has driven the exploration and application of Laparoscopy and Endoscopy Cooperative Surgery (LECS) in the management of Stage Ⅱ gastric cancer. To mitigate the potential risk of peritoneal micrometastasis associated with conventional procedures, LECS has evolved toward modified non-exposed techniques. These refinements strictly adhere to the tumor-free principle, effectively minimizing the risk of peritoneal seeding caused by tumor cell shedding. In terms of surgical precision, the synergy between endoscopy and laparoscopy not only accurately delineates tumor boundaries to ensure negative margins (R0 resection), but also provides the technical feasibility required to safely perform function-preserving procedures. Furthermore, this dual approach affords direct visual guidance during gastrointestinal reconstruction, thereby contributing to a reduced incidence of postoperative complications. Regarding safety, standardized laparoscopic operations guarantee the completeness of systematic D2 lymphadenectomy, while the physical closure mechanisms of non-exposed techniques effectively prevent the dissemination of cancer cells. Nevertheless, the clinical application of LECS currently faces several practical challenges. These include a lack of high-level evidence regarding long-term survival, uncertainties in preoperative imaging-based staging, and the steep learning curve associated with interdisciplinary collaboration. Moving forward, bolstered by robotic-assisted surgery, indocyanine green (ICG) fluorescence navigation, and standardized multidisciplinary team (MDT) workflows, LECS is poised to accelerate toward greater precision and individualization, further enriching and optimizing surgical treatment strategies for gastric cancer.