Please select the eligibility criteria that correspond to the clinical trial below.
Title: The STOMACH Trial: Surgical Technique, Open Versus Minimally-invasive Gastrectomy After CHemotherapy
Brief Summary: Laparoscopic surgery has been shown to provide important advantages in comparison with open procedures in the treatment of several malignant diseases, such as less peri-operative blood loss, faster patient recovery and shorter hospital stay. All while maintaining similar results with regard to tumour resection margin and oncological survival. In gastric cancer the role of laparoscopic surgery remains unclear.

Current recommended treatment for gastric cancer consists of radical resection of the stomach, combined with lymfadenectomy. The extent of lymfadenectomy is considered a marker for radicality of surgery and quality of care. Therefore, It is imperative that a new surgical technique should be non-inferior with regard to radicality and lymph node yield.

Preliminary studies show promising results for laparoscopic gastrectomy, but the number of studies is small and due to lower incidence of gastric cancer in the West they are often underpowered. A prospective randomised clinical trial is indicated in order to establish the optimal surgical technique in gastric cancer: open versus minimally invasive gastrectomy.

Results of the STOMACH trial will further aid in determining the optimal surgical technique in patients with gastric cancer.


Options:
A: Inclusion Criteria:

* Histologically confirmed adenocarcinoma of stomach
* Age: 18-80 years
* Performance status: ECOG 0-1
* Informed consent should be signed
* EGD finding of early gastric cancer
* EUS finding of mucosa and submucosa cancer
* The location of the tumor should be antrum, angle, lower body in greater curvature in UGIS
* No evidence of distant metastasis in abdomen CT, and chest PA
* Regional lymph node metastasis confined to perigastric node (N1) in CT and EUS

Exclusion Criteria:

* Any comorbidity obviating major surgery
* Contraindication of laparoscopy: severe cardiac disease, abdominal wall hernias, diaphragmatic hernias, uncorrected coagulopathies, portal hypertension, pregnancy
* Previous upper abdominal operation
* Indication of EMR: well or moderately differentiated adenocarcinoma, less than 2 cm in EGC type I and IIa, less than 1cm in EGC type IIb and IIc, no ulceration
* Complicated case needed to get emergency operation
* Any accompanying surgical condition needed to be performed in same time
B: Inclusion Criteria:

* Age equal to or above 18 years
* Primary adenocarcinoma of stomach, indication for total gastrectomy with curative intent.
* Neoadjuvant therapy (epirubicin, cisplatin, capecitabine)
* Surgical resectable (T1-3, N0-1, M0)
* Informed consent

Exclusion Criteria:

* Previous or coexisting cancer
* Previous surgery of the stomach
* ASA classification (American Society of Anaesthesiologists) score 4 or higher
C: Inclusion Criteria:

* histologically proven primary gastric adenocarcinoma
* T2 or T3 or T4a, N0 or N1 or N2 or N3a (AJCC 7th), which is assessed by computed tomography (CT) scan - mid 1/3 or low 1/3 location
* No evidence of other distant metastasis
* not stump carcinoma,(vi) aged 20-80 year old
* performance status (PS) of 0 or 1 on Eastern Cooperative Oncology Group (ECOG) scale
* no prior treatment of chemotherapy or radiation therapy against any other malignancies, and no prior treatment for gastric cancer including endoscopic mucosal resection
* adequate organ functions defined as indicated below:

  * WBC 3000/mm3, WBC 12 000/mm3
  * Hb 8.0 g/dl without any transfusion 2 weeks before enrollment
  * Plt 100 000/mm3
  * AST 100 IU/l
  * ALT 100 IU/l
  * T.Bil 2.0 mg/dl
  * written informed consent

Exclusion Criteria:

* active double cancer (synchronous double cancer and metachronous double cancer within five disease-free years), excluding carcinoma in situ (lesions equal to intraepithelial or intramucosal cancer)
* pregnant or breast-feeding women
* severe mental disorder
* systemic administration of corticosteroids
* unstable angina or myocardial infarction within 6 months of the trial
* unstable hypertension
* severe respiratory disease requiring continuous oxygen therapy
* previous upper abdominal surgery except laparoscopic cholecystectomy
D: Inclusion Criteria:

1. pathologically proven gastric adenocarcinoma
2. age: 20 \~ 80 years
3. preoperative stage: cT1N0M0, cT1N1M0, cT2aN0M0
4. no history of other cancer
5. no history of chemotherapy or radiotherapy
6. written informed consent

Exclusion Criteria:

1. ASA \>3
2. combined resection
3. total gastrectomy

Answer: B