The Efficacy and Safety of Laparoscopic Proximal Gastrectomy With LPG-tbROSF Versus LTG for Localized Proximal Gastric Cancer.

Inclusion criteria

• Aged from 18 to 75 years old;
• Histologically confirmed proximal gastric adenocarcinoma, CT1-2N0M0 stage;
• The tumor was located in the proximal third of the stomach.
• ECOG score of 0 or 1;
• D1+ or D2 dissection according to guidelines (depending on tumor location and intraoperative evaluation).
• ASA grade I to III;
• The preoperative nutritional status of the patients was good without severe malnutrition.
• Voluntarily sign informed consent.

Exclusion criteria

• Concurrent with other active malignant tumors, or a history of other malignant tumors within 5 years (excluding basal cell carcinoma of the skin and carcinoma in situ of the cervix);
• Severe cardiovascular diseases: such as NYHA class Ⅲ and above cardiac dysfunction, recent myocardial infarction (within 6 months), refractory hypertension or arrhythmia;
• Severe respiratory diseases: severe impairment of lung function (FEV1%<50%) or chronic respiratory failure;
• Severe liver and kidney dysfunction: ALT/AST > 3 times the upper limit of normal, or eGFR < 30 mL/min/1.73m²;
• patients complicated with other major chronic diseases, such as active tuberculosis, rheumatoid, systemic lupus erythematosus and other autoimmune diseases that affect surgical tolerance;
• Tumor imaging suggested the presence of distant metastasis (M1) or regional lymph node involvement, and the tumor was unresectable.
• Complicated with other upper gastrointestinal diseases, such as active gastric ulcer, pyloric obstruction, persistent bleeding, which seriously affect the operation;
• Previous major gastric or upper abdominal surgery (such as subtotal gastrectomy, esophagogastric anastomosis, etc.) affecting the reconstruction method;
• Received preoperative neoadjuvant chemoradiotherapy or targeted therapy (unless specifically permitted by the study design);
• Pregnant or lactating women;
• Patients with mental disorders, cognitive impairment, poor compliance, inability to understand the study content, or inability to cooperate with the follow-up;
• Severe malnutrition before surgery: BMI < 16 kg/m² or albumin < 25 g/L;
• Other individual conditions deemed unsuitable for enrollment by the investigator (e.g., poor willingness to cooperate, high risk of loss to follow-up, etc.).