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: Robotic Total Gastrectomy for Locally Advanced Proximal Gastric Cancer

Eligibility criteria:
Inclusion Criteria:

          -  Age between 18 to 75 years old

          -  Primary gastric adenocarcinoma (papillary, tubular, mucinous, signet ring cell, or
             poorly differentiated) confirmed pathologically by endoscopic biopsy

          -  Locally advanced tumor in the upper third or middle third of stomach without invading
             the greater curvature (cT2-4a, N-/+, M0 at preoperative evaluation according to the
             AJCC (American Joint Committee on Cancer) Cancer Staging Manual Seventh Edition)

          -  No distant metastasis, no direct invasion of pancreas, spleen or other organs nearby
             in the preoperative examinations

          -  Performance status of 0 or 1 on ECOG (Eastern Cooperative Oncology Group) scale

          -  ASA (American Society of Anesthesiology) class I to III

          -  Written informed consent

        Exclusion Criteria:

          -  Pregnant and lactating women

          -  Suffering from severe mental disorder

          -  History of previous upper abdominal surgery (except for laparoscopic cholecystectomy)

          -  History of previous gastric surgery (including ESD/EMR (Endoscopic Submucosal
             --Dissection/Endoscopic Mucosal Resection )for gastric cancer)

          -  Enlarged or bulky regional lymph node （diameter over 3cm）supported by preoperative
             imaging including enlarged or bulky No.10 lymph node

          -  History of other malignant disease within the past 5 years

          -  History of previous neoadjuvant chemotherapy or radiotherapy

          -  History of unstable angina or myocardial infarction within the past 6 months

          -  History of cerebrovascular accident within the past 6 months

          -  History of continuous systematic administration of corticosteroids within 1 month

          -  Requirement of simultaneous surgery for other disease

          -  Emergency surgery due to complication (bleeding, obstruction or perforation) caused by
             gastric cancer

          -  FEV1<50% of the predicted values

          -  Splenectomy must be performed due to the obvious tumor invasion in spleen or spleen
             blood vessels.
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