Objective:To investigate the early clinical outcomes of anterior cervical discectomy and fusion (ACDF) in the treatment of two-segment cervical spondylotic myelopathy (CSM) using a cervical soft endoscopic minimally invasive system.Methods:A retrospective follow-up study was conducted on the medical records of 23 patients with two-segment cervical myelopathy who underwent ACDF using a soft endoscopic cervical spine minimally invasive system at the Third Affiliated Hospital of Southern Medical University between October 2022 and December 2023. The cohort included 15 males and 8 females, aged 37-79 years (58.52±11.77 years). The affected cervical segments included: C 3, 4 and C 4, 5 in 2 cases; C 3, 4 and C 5, 6 in 3 cases; C 4, 5 and C 5, 6 in 10 cases; C 5, 6 and C 6, 7 in 7 cases; and C 4, 5 and C 6, 7 in 1 case. Clinical outcomes were evaluated based on the Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) for neck and shoulder pain, assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Additional data recorded included incision length, intraoperative blood loss, operative time, postoperative complications, and the presence of prevertebral soft tissue edema. The improvement rate of JOA scores at the final follow-up was also calculated. Results:All patients successfully underwent surgery and completed follow-up, with follow-up durations ranging from 3 to 6 months (4.01±0.98 months). The mean operative time was 80.09±22.66 min (range: 53-127 min), and the mean incision length was 3.25±0.32 cm (range: 3-4 cm). Estimated blood loss ranged from 10 to 100 ml, with a mean of 34.78±24.1 ml. Postoperative drainage ranged from 0 to 80 ml (mean: 23.13±26.1 ml), and postoperative hospitalization durations ranged from 4 to 12 days (6.83±2.59 days). JOA scores improved significantly from a preoperative median of 9.00(8.00, 10.00) to 12.00(11.00, 14.00) at 1 week, 13.00(12.00, 14.00) at 1 month, and 15.00(15.00, 16.00) at 3 months postoperatively (χ 2=220.492, P<0.001). VAS scores for neck and shoulder pain also improved significantly from a preoperative median of 5.00(4.00, 6.00) to 3.00(2.00, 3.00) at 1 week, 2.00(2.00, 3.00) at 1 month, and 2.00(1.00, 2.00) at 3 months postoperatively (χ 2=170.869, P<0.001). No postoperative complications such as dysphagia, hoarseness, nerve injury, cerebrospinal fluid leakage, or intraspinal hematoma were observed. Imaging revealed no significant prevertebral soft tissue edema. At the final follow-up, the improvement rate of JOA scores resulted in 14 cases rated as excellent and 9 as good. Conclusions:ACDF using a cervical soft endoscopic minimally invasive system demonstrates satisfactory clinical outcomes for the treatment of two-segment CSM. This technique reduces the incidence of common complications associated with both open and traditional endoscopic surgeries.

Objective:To report the 5-year survival outcomes and recurrence patterns of robotic total gastrectomy (RTG) for locally advanced proximal gastric cancer in order to provide more valuable long-term follow-up results for clinical practice.Methods:This was a prospective, single-arm, open-label clinical trial (FUGES-014; Clinical-Trials.gov, NCT03524287). Patients with locally advanced proximal gastric cancer who underwent RTG at Fujian Medical University Union Hospital from March 5, 2018, to February 10, 2020, were included in the analysis. To evaluate the long-term efficacy of RTG in the most objective manner possible, we performed a propensity score-matched (1∶2) comparative analysis with historical control patients who had undergone laparoscopic total gastrectomy (LTG) from the FUGES-002 study (ClinicalTrials.gov, NCT02333721) in which the 5-year disease-free survival (DFS), 5-year overall survival (OS), and recurrence patterns were compared between the two groups.Results:Prior to matching, there were 48 cases in the RTG group and 263 cases in the LTG group; patients in the LTG group had more advanced cT and pT stages ( P=0.044 and 0.006, respectively) compared to the RTG group. After matching, there were 48 cases in the RTG group and 96 cases in the LTG group; however, no statistically significant differences were observed in the baseline clinical characteristics between the two groups (all P>0.05). Both groups had a median follow-up of 72 months. The 5-year DFS rates were 75.0% (95%CI: 63.7%- 88.3%) in the RTG group and 61.4% (95%CI: 52.5%-72.0%) in the LTG group ( P=0.116). Similarly, the 5-year OS rates were 79.2% (95%CI: 68.5%-91.5%) and 64.6% (95%CI: 55.7%-74.9%) in the RTG and LTG groups, respectively ( P=0.100). Within 5 years after surgery, tumor recurrence occurred in 10 patients (20.8%) in the RTG group and 33 patients (34.4%) in the LTG group ( P=0.124), and peritoneal recurrence was the predominant pattern in both groups (8.3%[4/48] vs. 10.4%[10/96]; risk difference: -0.02, P=0.554). Gastric cancer-related death was the predominant cause of death in both groups (16.7% [8/48] vs. 31.2% [30/96]; risk difference: -0.15, P=0.064). Among patients stratified by different pathological stages, no statistically significant differences were found in DFS, OS, or recurrence rates between the RTG and LTG groups (all P>0.05). Conclusions:We find the long-term oncological outcomes of RTG for locally advanced proximal gastric cancer to be noninferior to those of LTG. RTG should therefore be considered as a valid option for standardized minimally invasive surgery for locally advanced proximal gastric cancer.

Objective:To compare the biomechanical stability of a novel interlocking intramedullary nail (nIMN) with that of a traditional interlocking intramedullary nail (tIMN) in the treatment of type AO 32-A3 femoral shaft fractures using a finite element analysis.Methods:A healthy adult male volunteer, aged 30 years old and weighing 70 kg, was selected for collection of his CT scan data of the femur. A three-dimensional finite element model of the femur was established using software Mimics 17.0 and Geomagic Studio. After femoral shaft fractures of AO/OTA types 32-A3a, 32-A3b, and 32-A3c were simulated, nIMN and tIMN were assembled respectively. After boundary conditions and material properties of the models were set based on reference literature, 4 load states were simulated: vertical standing, slow walking, fast walking, and descending stairs. The displacements and stress distribution at the femoral fracture ends under the same conditions were compared between nIMN and tIMN schemes of fixation. The stabilities of each fracture model at different fixation schemes and load states were analyzed.Results:In the 4 load states simulated, the displacements of the fracture ends averaged 0.129 mm, and the maximum stresses 111.00 MPa. The smallest displacement and maximum stress (0.014 mm and 29.48 MPa) were found in the vertical standing in the femoral shaft fracture of type 32-A3c fixed with nIMN. The largest displacement and maximum stress (0.325 mm and 242.98 MPa) were found in descending stairs in the femoral shaft fracture of type 32-A3a fixed with tIMN. In femoral shaft fractures of types 32-A3a, 32-A3b, and 32-A3c, regardless of tIMN or nIMN fixation, the displacement and maximum stress increased with the load, with the femoral shaft fracture of type 32-A3a being particularly evident. nIMN fixation resulted in lower displacements and maximum stresses in AO/OTA types 32-A3a, 32-A3b, and 32-A3c than tIMN fixation. Taking descending stairs as an example, the overall maximum stress occurred on the proximal part of the femur and the surrounding area of Adams'arc, with the maximum stress fluctuating between 86.62 and 242.98 MPa. The maximum stress at the fracture end fluctuated between 0.44 and 56.49 MPa. The stress mainly concentrated on the medial part, and decreased from type 32-A3a to type 32-A3b to type 32-A3c.Conclusion:In type AO 32-A3 femoral shaft fractures, nIMN leads to a smaller fracture end displacement and a lower maximum stress than tIMN, indicating better rotational stability.

Objective:To investigate the impact of sliding distance of the fmoral neck system (FNS) on the curative efficacy of displaced femoral neck fractures.Methods:A retrospective study was conducted to analyze the clinical data of the 179 patients with displaced femoral neck fracture who had been treated by FNS fixation at Department of Orthopaedics, The Second General Hospital of Fuzhou between September 2019 and September 2023. Based on the FNS sliding distance measured on X-ray films on the day after surgery or one day after surgery, the patients were assigned into 2 groups: a short sliding distance group [sliding distance ≤5 mm, n=55; 35 males, 20 females; median age: 50.0 (34.0, 59.0) years; body mass index (BMI): (24.0±2.4) kg/m 2] and a long sliding distance group [5 mm 0.05). At postoperative 3, 6, and 12 months, the distances of femoral neck shortening in the short sliding distance group [2.5 (0.7, 3.5) mm, 2.6 (0.7, 3.5) mm, and 2.7 (0.7, 3.5) mm] were significantly shorter than those in the long sliding distance group [3.2 (1.3, 5.7) mm, 3.2 (1.3, 7.1) mm, and 3.2 (1.4, 7.1) mm] ( P<0.05). The incidence of moderate-to-severe shortening at one year after surgery in the long sliding distance group [26.6% (33/124)] was significantly higher than that in the short sliding distance group [3.6%(2/55)] ( P<0.05). No significant differences were found between the 2 groups in tip-apex distance, operation time, intraoperative blood loss, fracture reduction quality, fracture healing time, or incidence of complications ( P>0.05). At the last follow-up, the Harris Hip Score in the short sliding distance group [93.5 (88.7, 96.2) points] was significantly higher than that in the long sliding distance group [90.1 (82.9, 94.9) points] ( P<0.05). Conclusion:In the treatment of displaced femoral neck fractures with FSN fixation, compared with those with a long sliding distance, the patients with a short sliding distance demonstrate superior outcomes in postoperative femoral neck shortening and functional recovery of the hip, but no significant difference in the incidence of complications.

Objective:To investigate the early clinical outcomes of anterior cervical discectomy and fusion (ACDF) in the treatment of two-segment cervical spondylotic myelopathy (CSM) using a cervical soft endoscopic minimally invasive system.Methods:A retrospective follow-up study was conducted on the medical records of 23 patients with two-segment cervical myelopathy who underwent ACDF using a soft endoscopic cervical spine minimally invasive system at the Third Affiliated Hospital of Southern Medical University between October 2022 and December 2023. The cohort included 15 males and 8 females, aged 37-79 years (58.52±11.77 years). The affected cervical segments included: C 3, 4 and C 4, 5 in 2 cases; C 3, 4 and C 5, 6 in 3 cases; C 4, 5 and C 5, 6 in 10 cases; C 5, 6 and C 6, 7 in 7 cases; and C 4, 5 and C 6, 7 in 1 case. Clinical outcomes were evaluated based on the Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) for neck and shoulder pain, assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Additional data recorded included incision length, intraoperative blood loss, operative time, postoperative complications, and the presence of prevertebral soft tissue edema. The improvement rate of JOA scores at the final follow-up was also calculated. Results:All patients successfully underwent surgery and completed follow-up, with follow-up durations ranging from 3 to 6 months (4.01±0.98 months). The mean operative time was 80.09±22.66 min (range: 53-127 min), and the mean incision length was 3.25±0.32 cm (range: 3-4 cm). Estimated blood loss ranged from 10 to 100 ml, with a mean of 34.78±24.1 ml. Postoperative drainage ranged from 0 to 80 ml (mean: 23.13±26.1 ml), and postoperative hospitalization durations ranged from 4 to 12 days (6.83±2.59 days). JOA scores improved significantly from a preoperative median of 9.00(8.00, 10.00) to 12.00(11.00, 14.00) at 1 week, 13.00(12.00, 14.00) at 1 month, and 15.00(15.00, 16.00) at 3 months postoperatively (χ 2=220.492, P<0.001). VAS scores for neck and shoulder pain also improved significantly from a preoperative median of 5.00(4.00, 6.00) to 3.00(2.00, 3.00) at 1 week, 2.00(2.00, 3.00) at 1 month, and 2.00(1.00, 2.00) at 3 months postoperatively (χ 2=170.869, P<0.001). No postoperative complications such as dysphagia, hoarseness, nerve injury, cerebrospinal fluid leakage, or intraspinal hematoma were observed. Imaging revealed no significant prevertebral soft tissue edema. At the final follow-up, the improvement rate of JOA scores resulted in 14 cases rated as excellent and 9 as good. Conclusions:ACDF using a cervical soft endoscopic minimally invasive system demonstrates satisfactory clinical outcomes for the treatment of two-segment CSM. This technique reduces the incidence of common complications associated with both open and traditional endoscopic surgeries.

Objective:To report the 5-year survival outcomes and recurrence patterns of robotic total gastrectomy (RTG) for locally advanced proximal gastric cancer in order to provide more valuable long-term follow-up results for clinical practice.Methods:This was a prospective, single-arm, open-label clinical trial (FUGES-014; Clinical-Trials.gov, NCT03524287). Patients with locally advanced proximal gastric cancer who underwent RTG at Fujian Medical University Union Hospital from March 5, 2018, to February 10, 2020, were included in the analysis. To evaluate the long-term efficacy of RTG in the most objective manner possible, we performed a propensity score-matched (1∶2) comparative analysis with historical control patients who had undergone laparoscopic total gastrectomy (LTG) from the FUGES-002 study (ClinicalTrials.gov, NCT02333721) in which the 5-year disease-free survival (DFS), 5-year overall survival (OS), and recurrence patterns were compared between the two groups.Results:Prior to matching, there were 48 cases in the RTG group and 263 cases in the LTG group; patients in the LTG group had more advanced cT and pT stages ( P=0.044 and 0.006, respectively) compared to the RTG group. After matching, there were 48 cases in the RTG group and 96 cases in the LTG group; however, no statistically significant differences were observed in the baseline clinical characteristics between the two groups (all P>0.05). Both groups had a median follow-up of 72 months. The 5-year DFS rates were 75.0% (95%CI: 63.7%- 88.3%) in the RTG group and 61.4% (95%CI: 52.5%-72.0%) in the LTG group ( P=0.116). Similarly, the 5-year OS rates were 79.2% (95%CI: 68.5%-91.5%) and 64.6% (95%CI: 55.7%-74.9%) in the RTG and LTG groups, respectively ( P=0.100). Within 5 years after surgery, tumor recurrence occurred in 10 patients (20.8%) in the RTG group and 33 patients (34.4%) in the LTG group ( P=0.124), and peritoneal recurrence was the predominant pattern in both groups (8.3%[4/48] vs. 10.4%[10/96]; risk difference: -0.02, P=0.554). Gastric cancer-related death was the predominant cause of death in both groups (16.7% [8/48] vs. 31.2% [30/96]; risk difference: -0.15, P=0.064). Among patients stratified by different pathological stages, no statistically significant differences were found in DFS, OS, or recurrence rates between the RTG and LTG groups (all P>0.05). Conclusions:We find the long-term oncological outcomes of RTG for locally advanced proximal gastric cancer to be noninferior to those of LTG. RTG should therefore be considered as a valid option for standardized minimally invasive surgery for locally advanced proximal gastric cancer.

Objective:To compare the biomechanical stability of a novel interlocking intramedullary nail (nIMN) with that of a traditional interlocking intramedullary nail (tIMN) in the treatment of type AO 32-A3 femoral shaft fractures using a finite element analysis.Methods:A healthy adult male volunteer, aged 30 years old and weighing 70 kg, was selected for collection of his CT scan data of the femur. A three-dimensional finite element model of the femur was established using software Mimics 17.0 and Geomagic Studio. After femoral shaft fractures of AO/OTA types 32-A3a, 32-A3b, and 32-A3c were simulated, nIMN and tIMN were assembled respectively. After boundary conditions and material properties of the models were set based on reference literature, 4 load states were simulated: vertical standing, slow walking, fast walking, and descending stairs. The displacements and stress distribution at the femoral fracture ends under the same conditions were compared between nIMN and tIMN schemes of fixation. The stabilities of each fracture model at different fixation schemes and load states were analyzed.Results:In the 4 load states simulated, the displacements of the fracture ends averaged 0.129 mm, and the maximum stresses 111.00 MPa. The smallest displacement and maximum stress (0.014 mm and 29.48 MPa) were found in the vertical standing in the femoral shaft fracture of type 32-A3c fixed with nIMN. The largest displacement and maximum stress (0.325 mm and 242.98 MPa) were found in descending stairs in the femoral shaft fracture of type 32-A3a fixed with tIMN. In femoral shaft fractures of types 32-A3a, 32-A3b, and 32-A3c, regardless of tIMN or nIMN fixation, the displacement and maximum stress increased with the load, with the femoral shaft fracture of type 32-A3a being particularly evident. nIMN fixation resulted in lower displacements and maximum stresses in AO/OTA types 32-A3a, 32-A3b, and 32-A3c than tIMN fixation. Taking descending stairs as an example, the overall maximum stress occurred on the proximal part of the femur and the surrounding area of Adams'arc, with the maximum stress fluctuating between 86.62 and 242.98 MPa. The maximum stress at the fracture end fluctuated between 0.44 and 56.49 MPa. The stress mainly concentrated on the medial part, and decreased from type 32-A3a to type 32-A3b to type 32-A3c.Conclusion:In type AO 32-A3 femoral shaft fractures, nIMN leads to a smaller fracture end displacement and a lower maximum stress than tIMN, indicating better rotational stability.

Objective:To investigate the impact of sliding distance of the fmoral neck system (FNS) on the curative efficacy of displaced femoral neck fractures.Methods:A retrospective study was conducted to analyze the clinical data of the 179 patients with displaced femoral neck fracture who had been treated by FNS fixation at Department of Orthopaedics, The Second General Hospital of Fuzhou between September 2019 and September 2023. Based on the FNS sliding distance measured on X-ray films on the day after surgery or one day after surgery, the patients were assigned into 2 groups: a short sliding distance group [sliding distance ≤5 mm, n=55; 35 males, 20 females; median age: 50.0 (34.0, 59.0) years; body mass index (BMI): (24.0±2.4) kg/m 2] and a long sliding distance group [5 mm 0.05). At postoperative 3, 6, and 12 months, the distances of femoral neck shortening in the short sliding distance group [2.5 (0.7, 3.5) mm, 2.6 (0.7, 3.5) mm, and 2.7 (0.7, 3.5) mm] were significantly shorter than those in the long sliding distance group [3.2 (1.3, 5.7) mm, 3.2 (1.3, 7.1) mm, and 3.2 (1.4, 7.1) mm] ( P<0.05). The incidence of moderate-to-severe shortening at one year after surgery in the long sliding distance group [26.6% (33/124)] was significantly higher than that in the short sliding distance group [3.6%(2/55)] ( P<0.05). No significant differences were found between the 2 groups in tip-apex distance, operation time, intraoperative blood loss, fracture reduction quality, fracture healing time, or incidence of complications ( P>0.05). At the last follow-up, the Harris Hip Score in the short sliding distance group [93.5 (88.7, 96.2) points] was significantly higher than that in the long sliding distance group [90.1 (82.9, 94.9) points] ( P<0.05). Conclusion:In the treatment of displaced femoral neck fractures with FSN fixation, compared with those with a long sliding distance, the patients with a short sliding distance demonstrate superior outcomes in postoperative femoral neck shortening and functional recovery of the hip, but no significant difference in the incidence of complications.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Objective:To compare and evaluate recurrence patterns after robotic-assisted gastrectomy (RAG) versus laparoscopic-assisted gastrectomy (LAG).Methods:This was a retrospective cohort study of 2915 consecutive patients with gastric adenocarcinoma confirmed by postoperative histology as T1-4aN0-3M0, who had undergone minimally invasive radical gastrectomy at four large gastric cancer treatment centers (Fujian Medical University Union Hospital: 1426 patients; the First Affiliated Hospital, Nanchang University: 1108; Tianjin Medical University Cancer Institute and Hospital: 196; and First Affiliated Hospital of Xi'an Jiaotong University: 185 cases) between 1 January 2015 and 30 June 2019. 930 patients had undergone RAG (RAG group) and 1985 had undergone LAG (LAG group). We assessed the following characteristics: age, sex, body mass index, American Society of Anesthesiologists score, comorbidities, tumor size, extent of surgery, extent of lymph node dissection, pT, pN, year of surgery, and adjuvant chemotherapy, after propensity score matching (1:1). There were no significant differences in baseline clinical characteristics between the two groups formed by propensity score matching (837 in each group) (all P>0.05). The 3-year recurrence-free survival (RFS), recurrence pattern, and conditional RFS were compared. Results:We detected no significant differences in the overall recurrence rate at 3 years (128/837 [15.3%] vs. 141/837 [16.8%], P=0.387) or time to recurrence (15.7±8.1 months vs. 16.4±8.4 months, P=0.449) between the RAG and LAG groups. Peritoneal recurrence was the most common type of recurrence in both groups (55 [6.6%] vs. 69 [8.2%], P=0.524). The difference in 3-year RFS between the RAG and LAG groups was not statistically significant (83.2% vs. 82.5%, P=0.781). We found that age > 60 years, total gastrectomy, and worse pT stage and pN stage were independent risk factors for recurrence in the study patients (all P<0.05), whereas the surgical procedure (RAG or LAG) was not an independent risk factor for RFS ( P=0.242). The 3-year conditional RFS at various time points was comparable between the two groups (1 year postoperatively: 84.6% vs. 84.7%, P=0.793; 3 years postoperatively: 91.5% vs. 94.9%, P=0.647). Conclusions:In this multicenter study of patients with locally resectable gastric cancer, we demonstrated that RAG performed by surgeons at large gastric cancer centers is not inferior to LAG in 3-year recurrence rate or recurrence patterns.