早期胃癌（EGC）治疗理念由扩大根治转向微创、精准与功能保留。前哨淋巴结（SN）导航及腹腔镜联合内镜手术（LECS）和机器人联合内镜手术（RECS）为胃局部切除、区域淋巴结清扫与功能保护提供新策略。EGC病人LECS中推荐经术中胃镜黏膜下直接注射吲哚菁绿（ICG），单点≤1.0 mL，遵循“宁浅勿深”原则，缓慢推注并观察黏膜下隆起确认注射成功。LECS和RECS术前需行放大染色胃镜排除多发病灶、超声胃镜评估T分期、增强CT排查淋巴结转移；术中SN冰冻切片病理检查结果决定局部切除或D2根治术，切缘阳性则补充扩大切除，浸润超T1b期则转D2根治术；术后内镜排查缝合缺陷、置入空肠营养管。上述方案形成EGC功能保留手术系统化流程，在保证根治性同时最大限度保留胃功能，改善病人术后生活质量。

The treatment paradigm for early gastric cancer (EGC) is shifting from extended radical resection toward minimally invasive, precise, and function-preserving approaches. Sentinel lymph node (SN) navigation, laparoscopic endoscopic cooperative surgery (LECS), and robotic endoscopic cooperative surgery (RECS) provide new strategies for local gastric resection, regional lymphadenectomy, and functional preservation. For indocyanine green (ICG) injection, intraoperative endoscopic submucosal direct injection is recommended, with a maximum volume of 1.0 mL per site, following the principle of “shallower rather than deeper,” injecting slowly and observing submucosal elevation to confirm successful delivery. Preoperative workup for LECS and RECS includes magnifying chromoendoscopy to rule out synchronous lesions, endoscopic ultrasonography for T staging, and contrast-enhanced CT to assess lymph node metastasis. Intraoperatively, frozen section pathology of the SN determines whether to proceed with local resection or D2 gastrectomy; positive margins warrant additional extended resection, and invasion beyond T1b stage requires conversion to D2 gastrectomy. Postoperatively, endoscopy is performed to check for suture defects, and a jejunal feeding tube is placed. This protocol constitutes a systematic procedure for function- preserving EGC surgery, aiming to maximize gastric preservation while ensuring oncological radicality and improving patients’ long-term postoperative quality of life.