The da Vinci Surgical System provides surgeons with a three-dimensional image view with greater clarity, which improves surgical precision, particularly in confined surgical spaces. Compared to laparoscopic surgery, robotic surgery has a shorter learning curve and may be a better choice for surgeons. However, some surgeons are susceptible to laparoscopic experience when performing robotic surgery, which can diminish the advantages of the robotic system. We discussed some key issues such as indications, use of energy instruments, surgical approach, lymph node dissection, and digestive tract reconstruction, from the habit of laparoscopic surgery, in light of our team's experience with robotic radical gastric cancer surgery and the latest literature, in order to help beginners better understand the robotic surgical system.

Objective:To investigate the feasibility and safety of laparoscopic purse- string suture clamps combined with multi-functional seal caps for esophagojejunal Roux-en-Y anastomosis during total laparoscopic radical total gastrectomy (TLTG).Methods:This was a retrospective descriptive study of 42 patients with primary gastric malignancies who underwent TLTG at the First Affiliated Hospital of Nanjing Medical University that utilized laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis between May, 2024 and January, 2025. The cohort included 33 males and 9 females, with a mean age of (67.7 ±9.5) years and a mean body mass index (BMI) of (23.9±2.9) kg/m 2. The American Society of Anesthesiologists (ASA) physical status classifications were I - II in 40 patients and III in 2 patients, and all patients were definitively diagnosed preoperatively via gastroscopy, dual-energy CT, and/or MRI. Tumor locations included the gastroesophageal junction (GEJ) in 28 cases (Siewert type II - III), the upper third of the stomach in 12 cases, and the middle third in 2 cases. The median distance of esophageal invasion was 1.3 cm, though in 10 cases this was ≥2 cm. Preoperative TNM staging was I-II in 17 patients and III in 25 patients. Surgical outcomes including operative time, anastomosis time, intraoperative blood loss, pathological results, and postoperative recovery were retrospectively analyzed. Results:All 42 operations were successful. The mean operative time was(212.5±26.4) minutes, and the average time from multi-functional seal cap placement to completion of the esophagojejunal anastomosis was (54.2±7.5) minutes. Mean intraoperative blood loss was (79.9±21.3) ml. Postoperative pathology confirmed R0 resection in all specimens, with a mean proximal esophageal margin distance of (2.1±1.6) cm. Furthermore, (51.9±15.1) lymph nodes on average were harvested from each patient; the mean time to oral intake was (149.5±41.4) hours; and the mean hospital stay was (11.3±5.4) days. Postoperative complications occurred in 6 patients: anastomotic leakage ( n=2), residual intra-abdominal infection ( n=1), pulmonary infection ( n=3), and Clavien-Dindo grade III or higher complications occurred in 2 patients. No recurrence, mortality, or anastomosis-related complications were observed within a median follow-up of 5.8 months (range 3.5-11.2). Conclusion:We find the application of the laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis in TLTG to be safe and feasible, with satisfactory short-term outcomes.

Adenocarcinoma of the esophagogastric junction (AEG) has shown an increasing incidence in recent years. The treatment strategy for AEG differs from that of gastric and esophageal cancers due to its unique anatomical location and biological behavior. Surgical resection remains the cornerstone of AEG treatment, with the choice of surgical approach based on Siewert classification, esophageal invasion length, and individual patient factors. The extent of lymph node dissection is determined by tumor location, stage, and patterns of lymph node metastasis. Digestive tract reconstruction aims to maximize the preservation of digestive function and reduce postoperative complications while achieving radical tumor resection. In recent years, minimally invasive surgical techniques, including laparoscopic and robotic surgery, have been increasingly applied in AEG treatment, with preliminary validation of their safety and feasibility. Additionally, the application of neoadjuvant therapy, targeted therapy, and immunotherapy has brought new hope for AEG treatment. This article reviews the current status of surgical treatment for AEG, including surgical approaches, lymph node dissection, digestive tract reconstruction, and neoadjuvant therapy, and discusses future directions in AEG surgical treatment.

Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Gastric cancer is a highly lethal malignant tumor, with early diagnosis being difficult and treatment outcomes influenced by multiple factors. In recent years, comprehensive treatment approach, incorporating surgery, chemotherapy, radiotherapy, targeted therapy, and immuno-therapy, has significantly improved efficacy. The advantages of comprehensive treatment are most important in patients with locally advanced and metastatic gastric cancer. For locally advanced cases, surgery serves as the core treatment, with various therapeutic modalities applied during the peri-operative period to enhance surgical outcomes. For metastatic patients, drug therapy is the primary method, supplemented by local treatments to achieve the best benefit. With the understanding of the molecular mechanisms underlying gastric cancer development, the use of molecular biomarkers for prognostic stratification and guidance for targeted therapy or immuno-therapy has become a crucial aspect of comprehensive treatment. Based on the latest research advancements, the authors discuss comprehensive treatment strategies for gastric cancer at different stages, offering insights into impro-ving efficacy and prognosis.

The da Vinci Surgical System provides surgeons with a three-dimensional image view with greater clarity, which improves surgical precision, particularly in confined surgical spaces. Compared to laparoscopic surgery, robotic surgery has a shorter learning curve and may be a better choice for surgeons. However, some surgeons are susceptible to laparoscopic experience when performing robotic surgery, which can diminish the advantages of the robotic system. We discussed some key issues such as indications, use of energy instruments, surgical approach, lymph node dissection, and digestive tract reconstruction, from the habit of laparoscopic surgery, in light of our team's experience with robotic radical gastric cancer surgery and the latest literature, in order to help beginners better understand the robotic surgical system.

Objective:To investigate the feasibility and safety of laparoscopic purse- string suture clamps combined with multi-functional seal caps for esophagojejunal Roux-en-Y anastomosis during total laparoscopic radical total gastrectomy (TLTG).Methods:This was a retrospective descriptive study of 42 patients with primary gastric malignancies who underwent TLTG at the First Affiliated Hospital of Nanjing Medical University that utilized laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis between May, 2024 and January, 2025. The cohort included 33 males and 9 females, with a mean age of (67.7 ±9.5) years and a mean body mass index (BMI) of (23.9±2.9) kg/m 2. The American Society of Anesthesiologists (ASA) physical status classifications were I - II in 40 patients and III in 2 patients, and all patients were definitively diagnosed preoperatively via gastroscopy, dual-energy CT, and/or MRI. Tumor locations included the gastroesophageal junction (GEJ) in 28 cases (Siewert type II - III), the upper third of the stomach in 12 cases, and the middle third in 2 cases. The median distance of esophageal invasion was 1.3 cm, though in 10 cases this was ≥2 cm. Preoperative TNM staging was I-II in 17 patients and III in 25 patients. Surgical outcomes including operative time, anastomosis time, intraoperative blood loss, pathological results, and postoperative recovery were retrospectively analyzed. Results:All 42 operations were successful. The mean operative time was(212.5±26.4) minutes, and the average time from multi-functional seal cap placement to completion of the esophagojejunal anastomosis was (54.2±7.5) minutes. Mean intraoperative blood loss was (79.9±21.3) ml. Postoperative pathology confirmed R0 resection in all specimens, with a mean proximal esophageal margin distance of (2.1±1.6) cm. Furthermore, (51.9±15.1) lymph nodes on average were harvested from each patient; the mean time to oral intake was (149.5±41.4) hours; and the mean hospital stay was (11.3±5.4) days. Postoperative complications occurred in 6 patients: anastomotic leakage ( n=2), residual intra-abdominal infection ( n=1), pulmonary infection ( n=3), and Clavien-Dindo grade III or higher complications occurred in 2 patients. No recurrence, mortality, or anastomosis-related complications were observed within a median follow-up of 5.8 months (range 3.5-11.2). Conclusion:We find the application of the laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis in TLTG to be safe and feasible, with satisfactory short-term outcomes.

Gastric cancer is a highly lethal malignant tumor, with early diagnosis being difficult and treatment outcomes influenced by multiple factors. In recent years, comprehensive treatment approach, incorporating surgery, chemotherapy, radiotherapy, targeted therapy, and immuno-therapy, has significantly improved efficacy. The advantages of comprehensive treatment are most important in patients with locally advanced and metastatic gastric cancer. For locally advanced cases, surgery serves as the core treatment, with various therapeutic modalities applied during the peri-operative period to enhance surgical outcomes. For metastatic patients, drug therapy is the primary method, supplemented by local treatments to achieve the best benefit. With the understanding of the molecular mechanisms underlying gastric cancer development, the use of molecular biomarkers for prognostic stratification and guidance for targeted therapy or immuno-therapy has become a crucial aspect of comprehensive treatment. Based on the latest research advancements, the authors discuss comprehensive treatment strategies for gastric cancer at different stages, offering insights into impro-ving efficacy and prognosis.

Adenocarcinoma of the esophagogastric junction (AEG) has shown an increasing incidence in recent years. The treatment strategy for AEG differs from that of gastric and esophageal cancers due to its unique anatomical location and biological behavior. Surgical resection remains the cornerstone of AEG treatment, with the choice of surgical approach based on Siewert classification, esophageal invasion length, and individual patient factors. The extent of lymph node dissection is determined by tumor location, stage, and patterns of lymph node metastasis. Digestive tract reconstruction aims to maximize the preservation of digestive function and reduce postoperative complications while achieving radical tumor resection. In recent years, minimally invasive surgical techniques, including laparoscopic and robotic surgery, have been increasingly applied in AEG treatment, with preliminary validation of their safety and feasibility. Additionally, the application of neoadjuvant therapy, targeted therapy, and immunotherapy has brought new hope for AEG treatment. This article reviews the current status of surgical treatment for AEG, including surgical approaches, lymph node dissection, digestive tract reconstruction, and neoadjuvant therapy, and discusses future directions in AEG surgical treatment.

With the increasing incidence of esophagogastric junction carcinoma, the application rate of proximal gastrectomy has been rising annually. There is a wide variety of methods for digestive tract reconstruction after proximal gastrectomy, and some of these reconstruction methods have been introduced relatively recently, with limited clinical experience, which led to a lack of standardization. Such a situation will inevitably result in inconsistent clinical outcomes of proximal gastrectomy with digestive tract reconstruction. To promote the standardization of digestive tract reconstruction after proximal gastrectomy, improve the clinical efficacy of proximal gastrectomy, and reduce the occurrence of postoperative complications, this article elaborates on the indications, surgical steps and technical points of the four methods after proximal gastrectomy recommended by the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy (2020 edition)", such as double tract, side overlap, double flaps and gastric tube reconstruction, providing guidance for the application of digestive tract reconstruction after proximal gastrectomy.