**Conflict of interest**

**5. Discussion**

56 Gastric Cancer - An Update

stoma (**Figure 21**).

Body mass index Operation time

Intraoperative blood loss Extent of lymph node dissection

Conversion to open surgery Postoperative complications Anastomosis-related complications

Non-anastomosis-related complications

**Table 1.** Characteristics of patients in whom ART-based anastomosis was performed (*n* = 160).

Anastomotic leakage Anastomotic hemorrhage Delayed gastric emptying

Pancreatic fistula

Intra-abdominal infection Intraperitoneal hemorrhage Surgical site infection Time to oral intake Postoperative hospital stay

Sex Age

D1+/D2 Clinical stage I/II/III/IV

isoperistaltic RY reconstruction.

Our policy of reconstruction after distal gastrectomy is as follows. The first choice is Billroth I reconstruction. If the remnant stomach is too small for Billroth I reconstruction, we perform

To date, we have used ART in 160 patients who underwent laparoscopic distal gastrectomy for stomach cancer between December 2013 and August 2017. These included 50 women and 110 men, with a mean age of 69.5 years and a mean body mass index (BMI) of 21.8. D1+ lymphadenectomy was performed in 81 patients, and D2 lymphadenectomy in 79 patients. The mean operation time was 227 minutes, and the mean blood loss volume was 47.3 mL. There were no intraoperative complications associated with reconstruction of the gastrointestinal tract, and none of the patients required conversion to open surgery. There were also no postoperative complications, such as anastomotic leakage or stenosis, associated with the reconstruction, and the mean postoperative hospital stay was 12 days (**Table 1**). Postoperative endoscopic examinations typically confirmed a large, elliptical anastomotic

The authors declare no conflict of interest.
