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: Effect of Laparoscopy-Assisted Distal Gastrectomy for Locally Advanced Gastric Cancer

Eligibility criteria:
Inclusion Criteria:

          1. Age: older than 18 years old，including 18 years old

          2. Pathologic finding by gastric endoscopy: confirmed gastric adenocarcinoma (papillary
             adenocarcinoma, tubular adenocarcinoma, mucinous adenocarcinoma, signet ring cell
             carcinoma, poorly differentiated adenocarcinoma)

          3. Cancer core: located at lower part of stomach

          4. Preoperative cancer stage : cT2-4a,N0-3,M0 (according to AJCC-7th TNM staging)

          5. surgery：subtotal gastrectomy (dissect more than 2/3 of stomach and total omentectomy)
             and D2 lymph node dissection

          6. ASA score: ≤ 3;ECOG performance status 0/1

          7. Informed consent patients (explanation about our clinical trials is provided to the
             patients or patrons, if patient is not available)

        Exclusion Criteria:

          1. Concurrent cancer patients or patient who was treated due to other types of cancer
             before the patient was diagnosed as a gastric cancer patient

          2. Patient who was treated by other types of treatment methods, such as chemotherapy,
             immunotherapy, or radiotherapy

          3. Patient who was received upper abdominal surgery (except, laparoscopic
             cholecystectomy)

          4. Patient who was treated because of systemic inflammatory disease

          5. Pregnant patient or lactating women

          6. Patient who suffer from bleeding tendency disease, such as hemophilia or patient
             taking anti-coagulant medication due to deep vein thrombosis

          7. serious mental illness

          8. gastric surgery (including for gastric ESD / EMR)

          9. imaging examinations showed regional integration lymph nodes (maximum diameter ≥ 3cm)

         10. other malignant diseases in 5 years

         11. have unstable angina or myocardial infarction within six months

         12. have cerebral infarction or cerebral hemorrhage within 6 months

         13. sustained systemic glucocorticoid treatment history within 1 month

         14. have other diseases needed operative treatment at the same time

         15. complications (bleeding, perforation, obstruction) required emergency surgery

         16. Pulmonary function tests FEV1 <50% of predicted value.
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.


Eligibility (NLI label): Entailment