Proximal Gastrectomy Vs Total Gastrectomy in Locally Advanced Upper Gastric Cancer After Neoadjuvant Therapy

Inclusion Criteria:

• To be eligible to participate in this study, all patients must meet all thefollowing criteria:

1. The subjects voluntarily joined the study and were able to sign the informedconsent with good compliance;

2. Age 18-75 years old (at the time of signing the informed consent), both maleand female;

3. Histologically and/or cytologically confirmed upper gastric carcinoma (adenocarcinoma), locally advanced according to AJCC Edition 8 criteria, cT3-4or N+M0 according to endoscopic ultrasound or enhanced CT/MRI scanning (combined with diagnostic laparoscopic exploration if necessary) , and consentto neoadjuvant therapy. Investigators assessed the lesion as resectable orpotentially resectable;

4. Have not received systematic treatment for the current disease, includinganti-tumor chemoradiotherapy/immunotherapy;

5. ECOG score 0-1;

6. Expected survival ≥6 months;

7. Preoperative chest, abdominal, pelvic CT or PET-CT to exclude distantmetastasis;

8. The major organs function well and meet the following criteria:

9. Blood routine examination (no blood transfusion within 14 days, nohematopoietic stimulating drugs to correct the state) : hemoglobin (Hb) ≥90g/L;Absolute neutrophil count (ANC) ≥1.5×109/L; Platelet (PLT) ≥80×109/L;

10. Biochemical examination: alanine aminotransferase (ALT) and aspartateaminotransferase (AST) ≤2.5×ULN; Serum total bilirubin (TBIL) ≤1.5×ULN; Serumcreatinine (Cr) ≤1.5×ULN, or creatinine clearance ≥60mL/min;

11. Coagulation function: activated partial thromboplastin time (APTT),International standardized ratio (INR), prothrombin time (PT) ≤1.5×ULN;

12. Doppler ultrasound evaluation: left ventricular ejection fraction (LVEF) ≥50%;

13. Assessed with adequate organ function by doctors. 9. Fertile subjects must useappropriate methods of contraception during the study period and within 120days after the end of the study, have a negative serological pregnancy testwithin 7 days prior to study enrollment, and must be non-lactating subjects.

Exclusion Criteria:

• To be eligible to participate in this study, all patients must meet all thefollowing criteria:

1. The subjects voluntarily joined the study and were able to sign the informedconsent with good compliance;

2. Age 18-75 years old (at the time of signing the informed consent), both maleand female;

3. Histologically and/or cytologically confirmed upper gastric carcinoma (adenocarcinoma), locally advanced according to AJCC Edition 8 criteria, cT3-4or N+M0 according to endoscopic ultrasound or enhanced CT/MRI scanning (combined with diagnostic laparoscopic exploration if necessary) , and consentto neoadjuvant therapy. Investigators assessed the lesion as resectable orpotentially resectable;

4. Have not received systematic treatment for the current disease, includinganti-tumor chemoradiotherapy/immunotherapy;

5. ECOG score 0-1;

6. Expected survival ≥6 months;

7. Preoperative chest, abdominal, pelvic CT or PET-CT to exclude distantmetastasis;

8. The major organs function well and meet the following criteria:

9. Blood routine examination (no blood transfusion within 14 days, nohematopoietic stimulating drugs to correct the state) : hemoglobin (Hb) ≥90g/L;Absolute neutrophil count (ANC) ≥1.5×109/L; Platelet (PLT) ≥80×109/L;

10. Biochemical examination: alanine aminotransferase (ALT) and aspartateaminotransferase (AST) ≤2.5×ULN; Serum total bilirubin (TBIL) ≤1.5×ULN; Serumcreatinine (Cr) ≤1.5×ULN, or creatinine clearance ≥60mL/min;

11. Coagulation function: activated partial thromboplastin time (APTT),International standardized ratio (INR), prothrombin time (PT) ≤1.5×ULN;

12. Doppler ultrasound evaluation: left ventricular ejection fraction (LVEF) ≥50%;

13. Assessed with adequate organ function by doctors. 9. Fertile subjects must useappropriate methods of contraception during the study period and within 120days after the end of the study, have a negative serological pregnancy testwithin 7 days prior to study enrollment, and must be non-lactating subjects.