Total Robotic Versus Robotic Assisted Distal Gastrectomy for Gastric Cancer

Inclusion Criteria: 1. Age from over 18 to under 75 years 2. Primary gastric adenocarcinoma (papillary, tubular, mucinous, signet ring cell, or poorly differentiated) confirmed pathologically by endoscopic biopsy 3. cT1-4a (clinical stage tumor), N-/+, M0 at preoperative evaluation according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th Edition 4. expected to perform distal gastrectomy with D1+/D2 lymph node dissection to obtain R0 resection surgicall results. 5. Performance status of 0 or 1 on Eastern Cooperative Oncology Group (ECOG) scale 6. American Society of Anesthesiology (ASA) class I to III 7. Written informed consent Exclusion Criteria: 1. Women during pregnancy or breast-feeding 2. Severe mental disorder 3. History of previous upper abdominal surgery (except laparoscopic cholecystectomy) 4. History of previous gastric surgery (except Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection (ESD/EMR) for gastric cancer) 5. Gastric multiple primary carcinoma 6. Enlarged or bulky regional lymph node （diameter over 3cm）supported by preoperative imaging 7. History of other malignant disease within the past 5 years 8. History of previous neoadjuvant chemotherapy or radiotherapy 9. History of unstable angina or myocardial infarction within the past 6 months 10. History of cerebrovascular accident within the past 6 months 11. History of continuous systematic administration of corticosteroids within 1 month 12. Requirement of simultaneous surgery for other disease 13. Emergency surgery due to complication (bleeding, obstruction or perforation) caused by gastric cancer 14. Forced expiratory volume in 1 second (FEV1)\<50% of the predicted values