Objective:To investigate the influencing factors of anastomotic leakage after laparoscopic intersphincter resection (ISR) for extremely low rectal cancer and construction of nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 812 patients who underwent laparoscopic ISR for extremely low rectal cancer in the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) from February 2012 to February 2022 were collected. There were 459 males and 353 females, aged (51±11)years. Observation indicators: (1) surgical situations; (2) follow-up; (3) influencing factors of postoperative anastomotic leakage; (4) construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. The COX proportional hazard model was used for univariate and multivariate analyses. The R software(3.5.1 version) was used to construct nomogram prediction model. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was used to evaluate the efficacy of the nomogram prediction model. The Bootstrap method was used for internal verification and to calculate the average consistency index (C-index). Results:(1) Surgical situations. All 812 patients underwent laparoscopic ISR for extremely low rectal cancer, including 388 cases undergoing partial ISR, 218 cases undergoing subtotal ISR and 206 cases undergoing complete ISR. All 812 patients underwent ileal protective ostomy, and there were 306 cases with double anastomosis and 203 cases with left colic artery preserved, respectively. The operation time and volume of intraoperative blood loss of 812 patients was (179±33)minutes and (33±13)mL, respectively. (2) Follow-up. All 812 patients were followed up for (13.5±0.9)months. Of the 812 patients, there were 62 cases with postoperative anastomotic leakage and the healing time of these cases was (33±6)days. (3) Influencing factors of postoperative anastomotic leakage. Results of multivariate analysis showed that male, neoadjuvant chemoradiotherapy, failure of reser-ving left colic artery were independent risk factors of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer ( hazard ratio=5.98, 4.00, 16.26, 95% confidence interval as 1.66-24.12, 1.30-12.42, 3.00-90.89, P<0.05). (4) Construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. According to the results of multivariate analysis, male, neoadju-vant chemoradiotherapy and failure of reserving left colic artery were used to construct the nomogram prediction model for anastomotic leakage after laparoscopic ISR for extremely low rectal cancer, and the score of these indexes in the nomogram prediction model was 50, 49, 93, respectively. The total score of these index corresponded to the incidence rate of anastomotic leakage. Results of ROC curve showed that the AUC of nomogram prediction model of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer was 0.87 (95% confidence interval as 0.80-0.93, P<0.05), with sensi-tivity and specificity 0.96 and 0.60, respectively. Results of internal verification showed that the C-index of nomogram prediction model was 0.87. Conclusion:Male, neoadjuvant chemoradiotherapy, failure of reserving left colic artery are independent risk factors of anastomotic leakage after laparo-scopic ISR for extremely low rectal cancer, and the nomogram prediction model based on these indexes can predict the incidence rate of postoperative anastomotic leakage.

Background:Cysteine and Glycine Rich Protein 1 (CSRP1) belongs to the cysteine-rich protein family, which contains a unique double-zinc finger motif and is important for development and cellular differentiation. Abnormal expression of CSRP1 was reported within several malignancies such as prostate cancer and acute myeloid leukemia. Here, we explored function of CSRP1 within colon adenocarcinoma (COAD) for the first time.Methods:The mRNA levels of CSRP1 in COADs were obtained from TCGA datasets. CSRP1 protein expressions in COADs were tested via immunohistochemistry staining. Patients' prognosis was evaluated using both univariate analysis and multivariate analysis. Two human COAD originated cancer cell lines, Caco-2, and HT-29, were used for cellular experiments including shRNA knockdown, proliferation assay, and migration assay. In vivo model was established using nude mice xenografts to further validate the role of CSRP1 in COAD progression.Results:The mRNA levels of CSRP1 are elevated in COAD specimens from patients with more advanced tumor stages and higher Carcinoembryonic Antigen (CEA) levels. In addition, higher CSRP1 mRNA level indicates worse COAD prognosis. Consistently, higher CSRP1 protein expression is correlated with worse overall survival according to both univariate and multivariate analysis, indicating that CSRP1 is a new COAD prognostic factor. Furthermore, COAD cells transfected with CSRP1-shRNAs exhibit attenuated proliferation and migration capacities. Finally, growth of xenografts originated from CSRP1-knockdown cells is inhibited comparing to the control ones.Conclusions:Expression of CSRP1 is positively correlated with COAD progression, which can promote tumor growth and migration. Higher CSRP1 can is a novel independent prognostic factor of COAD.

Abstract Background: Different from microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) colorectal cancer (CRC), almost 95% of CRC patients are microsatellite stable (MSS) which have been referred to as “cold” tumors showing primary resistance to immune checkpoint inhibitor (ICI). Pre-clinical research has elucidated the synergistic effect of ICI and anti-vascular therapy. Normalization of tumor blood vessels can improve immunotherapy. Moreover, chemotherapy has a pro-apoptotic effect on vascular endothelium to enhance the effect of promoting normalization of tumor blood vessels which can in turn promote tumor delivery of specific T cells and chemotherapy drugs into tumor tissue. Based on this, we plan to investigate the safety and efficacy of CAPOX combined with Bevacizumab plus Pembrolizumab (COBP) as neoadjuvant treatment of mismatch repair-proficient (pMMR) or MSS type locally advanced CRC patients. Methods: This is a prospective, single-center, single-arm, phase Ib study, mainly including patients with pMMR/MSS type locally advanced CRC, to explore the safety and feasibility of pembrolizumab combined with bevacizumab and CAPOX regime. Capecitabine will be administered orally at a dose of 1000 mg/m2 twice daily from days 1 to 14, every 3 weeks. Oxaliplatin, bevacizumab, and pembrolizumab will be given intravenously at a dose of 135 mg/kg, 7.5 mg/kg, and 200 mg respectively on day 1, every 3 weeks. After 4 cycles of treatment, patients will receive CAPOX for another one cycle. After neoadjuvant therapy, radical surgery will be performed for patients operable. The primary endpoints include adverse effects, R0 resection rate, pathologic complete response rate, and tumor regression grade. The second endpoints include 1/2/3-year disease-free survival, 1/2/3-year overall survival, and quality of life. Discussion: The COBP study is a single center phase Ib study, which aims to initially explore the safety and preliminary effectiveness of COBP regime in locally advanced CRC patients. We hope that the results of this study can provide a direction for future exploration and further improve the outcome of patients. Trial registration: ClinicalTrials.gov NCT05585814. Registered on October 19, 2022.

Abstract Background The conventional laparoscopic colorectal surgery requires four or more ports to accomplish the laparoscopic dissection, and a mini-laparotomy to remove the specimen, which is a main cause of postoperative pain and incision complications, and compromise the cosmetic results. Reduced port surgery and natural orifice specimen extraction (NOSE) surgery hold the promise to overcome these drawbacks. This study planned to compare peri-operative outcomes of patients with rectal-sigmoid cancer undergoing three-port laparoscopic anterior resection with NOSE (three-port NOSE LAR) to those of patients receiving conventional LAR. Methods Twenty-five patients with rectal-sigmoid cancer underwent three-port NOSE LAR between December 2018 and October 2020. For comparison, 50 patients with rectal-sigmoid cancer underwent conventional LAR in the same period were matched. The peri-operative outcomes were compared. Results Operating time of three-port NOSE group was slightly longer than that of conventional group (135 min vs. 121 min, p = .147). The incision length of three-port NOSE group was shorter than that of conventional group (2.9 cm vs. 7.4 cm, p = .000). Complication rates in three-port NOSE group and conventional group were similar (12.0% vs. 20.0%, p = .524). The tumor size was smaller in three-port NOSE group than the conventional group (2.1 cm vs. 3.5 cm, p = .000). Pain score was lower in three-port NOSE group than the conventional group at postoperative day 1 (1.6 vs. 3.0, p = 0.045) and day 2 (0.2 vs. 2.1, p = .003). The BIQ score was significantly higher in the three-port NOSE group compared to the conventional group (42.9 ± 3.5 vs. 38.2 ± 2.5, p = .002). Conclusions Three-port NOSE LAR for rectal-sigmoid cancer is feasible and provides similar peri-operative outcomes compared to conventional LAR. It reduces postoperative pain and produces better cosmesis.

Background ：Anastomotic leakage (AL) limits the outcome after laparoscopic anterior resection (LAR) for middle-low rectal cancer. The study investigated the efficacy of laparoscopic anastomosis enhancing suture (LAES), preventive ileostomy and transanal drainage tube placement in reducing anastomotic leakage after LAR for middle-low rectal cancer. Methods： From April 2016 to April 2019, a prospective cohort study was performed on consecutive patients who underwent LAR for middle-low rectal cancer in Changzheng hospital. The patients were divided into group A, B, C and D in which LAES, transanal drainage tube placement, protective ileostomy, and no preventive treatment were applied, respectively. Clinical characteristics, operative variables and postoperative complication were compared between the groups. Results ：Among 320 patients, 24 (7.5%) developed AL and incidence rate of AL was 1.3%, 12.5%, 1.3% and 15.0% in the four groups, respectively. Left colic artery preservation and neoadjuvant chemotherapy were found not associated with the incidence of AL. A total of 0, 2, 2 and 5 patients had anastomotic bleeding in the four groups, respectively. No patient underwent reoperation in group A and group C, while 5.0% (4/80) of the patients had reoperation in group B and group D due to grade C AL with severe symptoms. Conclusions： Compared with preventive ileostomy, LAES was effective in preventing AL after LAR for middle-low rectal cancer and relieving the complications of AL. The transanal drainage tube placement did not reduce the risk of AL. The study was retrospectively registered with the Chinese Clinical Trial Registry on 28 th June 2016 (code: ChiCTR-IOR-17011777).

Natural orifice specimen extraction surgery (NOSES) has been increasingly used in the field of colorectal surgery. The potential benefits of NOSES include reduction in postoperative pain, decreased postoperative analgesia and better cosmesis[1-3] . Conventional laparoscopic colorectal surgery utilizes four or five ports but here we report how this can be reduced to just three ports using NOSES to perform a laparoscopic sigmoidectomy.

目的 探讨腹腔镜下倒刺线行吻合口全层连续缝合加固对中低位直肠癌术后吻合口漏的预防作用.方法 针对吻合口漏易发因素设计了一整套手术方案,除了保护血供、改进吻合方式以及消除张力外,重点进行吻合口全层连续缝合加固,力求避免临时性末端回肠造口转流.结果 用上述方法对78例中低位直肠癌患者采用了吻合口缝合加固,术后均未发生吻合口漏.结论 吻合口缝合加固法可有效预防中低位直肠癌吻合口漏的发生.

Circulating tumor DNA (ctDNA) is a promising biomarker for detecting minimal residual disease (MRD) and for monitoring treatment of patients with colorectal cancers (CRC). Any technology used for this purpose, however, will face extreme performance demands. In order to build a high-performance multiplex next-generation sequencing (NGS) platform suitable for cancer MRD using ctDNA, we developed Accu-Act TM , an NGS-based assay capable of detecting low-frequency variants in plasma ctDNA with high precision. In our protocol, rolling-circle amplification is used to circularize denatured double-stranded cell-free DNA (cfDNA) and convert it into long tandem repeats, thus enabling consensus-based concatemer error correction. We demonstrated Accu-Act TM ’s sensitivity and specificity by testing it on cfDNA samples with known variant frequencies and cfDNA collected from healthy individuals (n = 100). Our results showed that the sensitivity of Accu-Act was 0.1% with an error rate of 1 in 1 million for 20ng of input cfDNA. Concordance analysis was performed using Accu-Act, a 61-gene assay, on 152 tumor/plasma pairings of preoperative samples derived from patients with CRC (stage I-IV). Depending on stage, we report 66-92% patient detection rate. Post-surgery ctDNA profiling was performed on 52 patients (stage I-IV) enrolled in our prospective MRD study. The results showed that 26% of patients had detectable postoperative ctDNA, among whom 72% had disease progression within two years. Only one out of the 41 patients without detectable postoperative ctDNA went on to relapse, and one patient died of a lung infection. Our study showed that ctDNA is a promising prognostic biomarker for CRC relapse after R0 resection (HR (95%CI) 33.00 (4.05 - 270), P TM NGS-based ctDNA assay has high accuracy and is suitable for MRD in CRC patients. Accu-Act TM should make a significant contribution in the development of personalized cancer treatment. Citation Format: Xinxing Li, Grace Zhao, Xianwen Zhang, Yanping Sun, Yi Wang, Canping Ruan, Paul Tang, Malek Faham, Shengrong Lin, Kang Ying, Zhiqian Hu. CRC MRD detection using Accu-Act TM NGS technology [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A035.

Intersphincter resection (ISR) is considered to be a superior technique offering sphincter preservation in patients with ultralow rectal cancer.1 Because high-definition laparoscopy offers wider and clearer vision into the narrow pelvic cavity and intersphincteric space, ISR has been further refined.2 However, functional outcome after ISR has not been optimal. More than half of patients receiving ISR suffer partial or even complete anal incontinence.3 We therefore propose a laparoscopic-assisted modified ISR, with the aim of improving sphincter function following ISR.

Abstract Circulating tumor DNA (ctDNA) is a promising biomarker for detecting minimal residual disease (MRD) and for monitoring treatment of patients with colorectal cancers (CRC). Any technology used for this purpose, however, will face extreme performance demands. In order to build a high-performance multiplex next-generation sequencing (NGS) platform suitable for cancer MRD using ctDNA, we developed Accu-ActTM, an NGS-based assay capable of detecting low-frequency variants in plasma ctDNA with high precision. In our protocol, rolling-circle amplification is used to circularize denatured double-stranded cell-free DNA (cfDNA) and convert it into long tandem repeats, thus enabling consensus-based concatemer error correction. We demonstrated Accu-ActTM’s sensitivity and specificity by testing it on cfDNA samples with known variant frequencies and cfDNA collected from healthy individuals (n = 100). Our results showed that the sensitivity of Accu-Act was 0.1% with an error rate of 1 in 1 million for 20ng of input cfDNA. Concordance analysis was performed using Accu-Act, a 61-gene assay, on 152 tumor/plasma pairings of preoperative samples derived from patients with CRC (stage I-IV). Depending on stage, we report 66-92% patient detection rate. Post-surgery ctDNA profiling was performed on 52 patients (stage I-IV) enrolled in our prospective MRD study. The results showed that 26% of patients had detectable postoperative ctDNA, among whom 72% had disease progression within two years. Only one out of the 41 patients without detectable postoperative ctDNA went on to relapse, and one patient died of a lung infection. Our study showed that ctDNA is a promising prognostic biomarker for CRC relapse after R0 resection (HR (95%CI) 33.00 (4.05 - 270), P<0.001). The Accu-ActTM NGS-based ctDNA assay has high accuracy and is suitable for MRD in CRC patients. Accu-ActTM should make a significant contribution in the development of personalized cancer treatment. Citation Format: Xinxing Li, Grace Zhao, Xianwen Zhang, Yanping Sun, Yi Wang, Canping Ruan, Paul Tang, Malek Faham, Shengrong Lin, Kang Ying, Zhiqian Hu. CRC MRD detection using Accu-ActTM NGS technology [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A035.

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in staging of rectal cancer (RC).Methods From January 2015 to January 2017,the clinical data of 204 patients with RC and received EUS and surgery were retrospectively analyzed.Patients were divided into surgery alone group (155 cases) and preoperative neoadjuvant chemoradiation therapy (CRT) plus surgery group (49 cases).The preoperative staging by EUS and postoperative pathological staging of two groups were compared.Kappa test was performed for statistical analysis.Results Compared with postoperative pathologic diagnosis,the accuracy rate of EUS in the evaluation of invasion depth of RC in surgery alone group was 81.9％ (127/155),and the accuracy rates in the diagnosis of Tis,T1,T2,T3 and T4 were 3/4,11/13,82.1％(32/39),91.1％(41/45) and 74.1％(40/54),respectively,with a good consistency (kappa=0.751,P＜0.01).However,the accuracy rate of EUS in the invasion depth of RC in CRT plus surgery group was 34.7％ (17/49),and the accuracy rates in the diagnosis of T2,T3 and T4 were 1/13,2/7 and 14/16,respectively,with a poor consistency (kappa =0.107,P=0.850).Compared with postoperative pathologic diagnosis,the diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis in surgery alone group was 70.3％ (109/155),and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 40.7％ (24/59) and 88.5％ (85/96),respectively,with a poor consistency (kappa=0.317,P＜0.01).The diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis of preoperative CRT plus surgery group was 51.0％ (25/49),and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 5/11 and 52.6％ (20/38),respectively,with a poor consistency (kappa =0.014,P =0.911).Conclusions EUS can accurately evaluate the depth of tumor invasion and lymph node metastasis in preoperative staging of RC,which may be helpful for determining clinical treatment strategy.However,for patients received CRT treatment,EUS has a limited value in diagnosing and staging the tumor.

Marital status has been found to be a prognostic factor for survival in various cancers, but its role in gallbladder cancer (GBC) has not been fully studied. In this study, we used the Surveillance, Epidemiology, and End Results Program (SEER)-registered database to analyze the survival of GBC patients with different marital status. A total of 6,627 GBC patients were selected from SEER database from 2004 to 2013. The age, race, grade, histologic type, AJCC stage, SEER stage and marital status were identified as independent prognostic factors. Married GBC patients had a higher 5-year cancer-specific survival (CSS) than that of unmarried ones (20.1% v.s. 17.8%, P < 0.05). Subgroup analyses showed that widowed patients had 14.0% less of 5-year CSS compared to married ones of stage I (55.9% v.s. 41.9%, P < 0.05), 14.7% of stage II (15.6% v.s. 10.9%, P < 0.05), and 1.5% of stage III + IV (2.9% v.s. 1.4%, P < 0.05). In addition, single is an independent prognostic factor at stage III + IV (HR = 1.225, 95%CI 1.054–1.423, P = 0.008). These results indicated that widowed patients were at a high risk of cancer-specific mortality and marriage can be a protective prognostic factor in CSS.

Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, PR China. [email protected]. Disclosure: The authors declare no conflicts of interest.

目前,结肠直肠癌仍以外科治疗为主,并朝着功能最佳化、创伤最小化的方向发展. 1991年,Jacobs等[1]率先完成腹腔镜结肠切除术以来, 各项循证医学证据已证明腹腔镜结肠直肠癌手术可取得与开腹手术相似的肿瘤学疗效, 且病人所受的手术创伤小,康复速度快,并发症发生少,安全可行,成为外科医师首选的手术方式[2-5],推荐为结肠直肠癌的标准手术方式[6].

The age-specific impact on the survival of gastric cancer patients with distant metastasis is still unclear. In this study, we identified 11, 299 gastric cancer patients with distant metastasis between 2004 and 2013 from Surveillance, Epidemiology, and End Results population-based dataset. Patients were divided into young (≤60) and elderly groups (>60). Kaplan-Meier methods and multivariable Cox regression were used for the analysis of long-term survival outcomes and risk factors. There were significant differences between the two groups in terms of race, primary site, grade, histologic type, surgery, marital status and clinical T stage (P<0.05). The 1- and 3-year cancer specific survival rates were 29.0% and 6.2% in young group and 22.8% and 4.8% in elderly group in both univariate (X2=116.430, P<0.001) and multivariate analysis (P<0.001). Young patients had significantly better 1- and 3-year cancer specific survival than elderly patients in each T stage. Age was further validated as an independent survival factor in all T stages (T1, T2, T3, T4 and TX, P<0.05). In conclusion, age was an independent prognostic factor for gastric cancer patients with distant metastasis.

Objective:To investigate the influence of different specimen extraction methods on the prognosis of patients who underwent laparoscopic anterior resection of rectal cancer (L-Dixon).Method: A retrospective analysis was made on the clinical data of 80 cases, who were diagnosed as rectal cancer and treated by laparoscopic anterior resection (L-Dixon) from August 2012 to May 2013 in our hospital. The patients were averagely divided into group A and B. The operation specimens of the group A were extracted from the incision in lower left abdomen and resected outside of the abdomen. While the specimens of the group B were resected in the abdomen and removed through a similar incision by a laparoscopic specimen bag.Result:All the patients got successful operation without a protectivestoma and conversion to laparotomy or Miles operation. There were no significant differences about operation time, amount of blood loss, intestinal function recovery and postoperative hospital stay between two groups(P>0.05). For patients in the group B, the recurrence and metastasis rate within 2 years after surgery was significantly lower than that in the group A(P<0.05).Conclusion: Specimen extraction is very important in laparoscopic anterior resection of rectal cancer (L-Dixon). We must strictly follow the principle of “no-touch”. Resecting the specimen in the abdomen and removed by a laparoscopic specimen bag is very reasonable and safe. It can effectively reduce the risk of tumor metastasis.

e23028 Background: Circulating tumor DNA (ctDNA) holds great potential as a biomarker for cancer management. Unfortunately, with a half-life of < 2hrs, ctDNA is present in miniscule quantities and can go undetected in peripheral blood. We hypothesized that blood collected from the portal vein may yield higher quantities of ctDNA than that collected elsewhere for colorectal cancers (CRC) due to the passage of blood from gastrointestinal organs through the portal vein prior to circulation. Methods: 10mL of peripheral blood was collected from 12 CRC patients prior to or during tumor removal surgery during which an additional 10 mL of blood drawn from the portal vein. ctDNA fragment length and concentration was measured for every pair of the resulting ctDNA, along with tissue gDNA, was sequenced using Accu-Act, a NGS panel of 61 genes which have implication of cancer treatments. Concordance of ctDNA mutation profiles from both collection sites and tumor were compared. Results: ctDNA was detected in all 12 sample pairs and a comparison of ctDNA from both collection sites revealed similar fragment lengths and concentration (12.26ng/ml, and peripheral vein: 10.83ng/ml). Little difference in concordance (compared to tumor) was observe. Though the average minor allele frequency of somatic mutations from portal venous ctDNA was slightly higher than that of peripheral venous ctDNA, the difference is not substantial. A mumber of mutaions with low allele frequcy (down to 0.1%, 2 copies), were detected in both sites, and from two independent DNA extractions from each sites. Conclusions: We have demonstrated the feasibility of obtaining portal venous ctDNA and reported no substantial difference between portal venous and peripheral venous ctDNA. Even the sensitivity and reporducbility of our Nebula-Firefly are very high, this analysis is still susceptible to sampling errors associated with the low copy number of mutated ctDNA in circulation and larger studies may provide more conclusive results.

家族性腺瘤性息肉病(familial adenomatous polyposis， FAP)是常染色体显性遗传疾病，以结肠直肠内布满大小不等的腺瘤性息肉为特征，好发于青年，一般15岁开始出现症状，20~30岁最为明显[1-2]。随着生活和环境的改变，其发病率逐渐升高，如不及时治疗，至中年时几乎全部病例都将发展为结肠直肠癌[3-4]。因此，亟需作出FAP正确的诊治策略。本研究结合我院20例FAP病例并文献复习，探讨FAP的临床特点、诊治及预后情况。

Gastric cancer is a common malignant tumor and ranks the third in China .In recent years,laparoscopic radical operation has been the important procedure for rapid rehabilitation after removal of gastric cancer , which reduces the incision and eleminates postoperative pain .The patient we described suffered from early gastric cancer located in the stomach angle .Radical distal gastric resection was performed with laparoscopy and Delta anastomosis was used for the reconstruction of the digestive tract .The operation lasted for 100 minutes with a 2.5 cm incision under the navel level .The patient ambulated 24 hours after surgery and was discharged 7 days after operation .This sdudy showed that laparoscopic radical gastrectomy is beneficial to patient ’ s postoperative recovery .