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: Total Robotic Versus Robotic Assisted Distal Gastrectomy for Gastric Cancer

Eligibility criteria:
Inclusion Criteria:

          1. Age from over 18 to under 75 years

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

          3. cT1-4a (clinical stage tumor), N-/+, M0 at preoperative evaluation according to the
             American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th Edition

          4. expected to perform distal gastrectomy with D1+/D2 lymph node dissection to obtain R0
             resection surgicall results.

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

          6. American Society of Anesthesiology (ASA) class I to III

          7. Written informed consent

        Exclusion Criteria:

          1. Women during pregnancy or breast-feeding

          2. Severe mental disorder

          3. History of previous upper abdominal surgery (except laparoscopic cholecystectomy)

          4. History of previous gastric surgery (except Endoscopic Submucosal
             Dissection/Endoscopic Mucosal Resection (ESD/EMR) for gastric cancer)

          5. Gastric multiple primary carcinoma

          6. Enlarged or bulky regional lymph node （diameter over 3cm）supported by preoperative
             imaging

          7. History of other malignant disease within the past 5 years

          8. History of previous neoadjuvant chemotherapy or radiotherapy

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

         10. History of cerebrovascular accident within the past 6 months

         11. History of continuous systematic administration of corticosteroids within 1 month

         12. Requirement of simultaneous surgery for other disease

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

         14. Forced expiratory volume in 1 second (FEV1)<50% of the predicted values
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