Patient case (clinical description): A 63-year-old man comes to the clinic for recent unintentional weight loss. The patient also has epigastric discomfort after meals. He has no known medical problems and takes no medications. His blood pressure is 130/75 and pulse rate is 88/min. He is not febrile. Upper endoscopy shows a lesion in the stomach that shows typical features of diffuse-type adenocarcinoma presenting with signet ring cells that do not form glands.

Patient's own account: I went to the clinic because I had been losing so much weight that it was concerning. I'm a 63-year-old guy, and it is something rather unusual. I'm always suffering from stomachache after every meal. I've never been sick, and I don't take any medicine. The doctor took my blood pressure and told me it was 130/75, and my pulse rate was 88/min. I'm not febrile! I also had to do an endoscopy, and they found a lesion in my stomach that shows typical features of stomach cancer. I'm totally devastated...

Clinical trial: Multicenter Study on Laparoscopic Total Gastrectomy for Advanced Gastric Cancer

Eligibility criteria:
Inclusion Criteria:

          1. Aged 18-75 years

          2. Tumor located in the middle or upper third of the stomach, and curative resection is
             expected to be achievable by total gastrectomy with D2 lymphadenectomy (also apply to
             multiple primary cancers);

          3. Primary lesion is pathologically diagnosed as gastric adenocarcinoma, such as
             papillary adenocarcinoma, tubular adenocarcinoma, mucinous adenocarcinoma, poorly
             cohesive carcinoma (including signet ring cell carcinoma and other variants), and
             mixed adenocarcinoma;

          4. Clinical stage T2-4aN0-3M0 (According to AJCC-8th TNM staging system);

          5. Expected survival > 6 months

          6. No invasion to Z-line;

          7. BMI (Body Mass Index) < 30 kg/m2

          8. No history of upper abdominal surgery (except for laparoscopic cholecystectomy);

          9. No prior treatment of chemotherapy, radiotherapy, targeted therapy, immunotherapy, etc

         10. Preoperative performance status (ECOG，Eastern Cooperative Oncology Group) of 0 or 1

         11. Preoperative ASA (American Society of Anesthesiologists) scoring: I-III

         12. Sufficient organ functions

         13. Written informed consent

        Exclusion Criteria:

          1. Preoperative examinations indicate regional fusion of enlarged lymph nodes (max
             diameter ≥ 3.0cm) or enlargment of spleen hilus lymph nodes

          2. Women during pregnancy or breast-feeding

          3. Synchronous or metachronous (within 5 years) malignancies

          4. Body temperature ≥ 38℃ before surgery or infectious disease with a systemic therapy
             indicated

          5. Severe mental disease

          6. Severe respiratory disease, FEV1 < 50% of predicted

          7. Severe hepatic and renal dysfunction

          8. Unstable angina pectoris or history of myocardial infarction within 6 months

          9. History of cerebral infarction or cerebral hemorrhage within 6 months

         10. Continuous systemic steroid therapy within 1 month (except for topical use)

         11. Gastric cancer complications (bleeding, perforation, obstruction) that requiring
             emergency surgery

         12. Patients are participating or have participated in another clinical trial (within 6
             months)
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.
Subject must be at most 75 Years

Eligibility (NLI label): Entailment