The aim of laparoscopic and endoscopic cooperative surgery (LECS) is to pursue radical resection while maximizing preservation of gastric function and the patient’s quality of life. For gastric tumors located in special sites—such as the esophagogastric junction, cardia, posterior gastric wall, gastric angle (incisura angularis), and antrum—the complex anatomy, special adjacent relationships, and limited operative space impose significant limitations on both pure endoscopic and pure laparoscopic approaches. LECS integrates the precise intraluminal localization of endoscopy with the minimally invasive manipulation and suturing/hemostatic capabilities of laparoscopy, thus offering unique advantages in treating tumors at these sites. However, its clinical indications remain clearly defined. The real challenge is not technical feasibility, but whether an individualized treatment strategy can be developed for each patient: when there is a risk of lymph node metastasis, standardized lymph node dissection should be performed; when there is no indication of functional compromise, the extent of resection should be carefully controlled to avoid overtreatment.