Prognostic models for resectable gastric cancer rarely integrate adipose tissue and immune-inflammatory parameters. This study evaluated the predictive value of preoperative relative fat mass (RFM) and the modified systemic inflammation score (mSIS), and explored their potential synergy with nanomedicine-based theranostics. We retrospectively analyzed 518 patients who underwent radical gastrectomy across three tertiary centers in China (overall enrollment period: 2010–2019). Preoperative CT-derived waist circumference at L3 was used to calculate RFM, with the optimal cutoff determined by ROC analysis using the Youden index. Univariate and multivariate Cox regressions identified independent prognostic factors and constructed the nutritional-inflammatory composite parameter RFMmSIS. Predictive performance was assessed using AUC, AIC, BIC, NRI, IDI, and DCA. Postoperative follow-up was conducted every 3 months during the first 2 years, every 6 months during years 3 through 5, and annually thereafter. Patients were randomly allocated to training (n = 362) and validation (n = 156) cohorts. RFM outperformed BMI for survival prediction (AUC: 0.584 vs. 0.503, P < 0.05) and was associated with worse 3-year overall survival (OS) (64.1

BACKGROUND:The prognostic accuracy of the AJCC 8th Edition ypTNM staging system for patients diagnosed with gastric cancer (GC) after neoadjuvant therapy (NAT) remains controversial. METHODS:Data from 1078 patients diagnosed with locally advanced GC, who underwent NAT at international multicenter institutions, were retrospectively analyzed. Optimal lymph node staging was determined based on overall survival (OS) and disease-specific survival (DSS), with the subsequent development of a novel ypTNM staging system. The prognostic performance of the AJCC 8th Edition ypTNM and modified staging systems were compared and validated using information obtained from databases in the United States. RESULTS:The optimal ypN cut-offs were 0, 1, and 8 nodes for ypN0-ypN3, respectively. The modified ypN category demonstrated superior prognostic discrimination between each adjacent stage, with significant differences in three-year OS (p=0.034, <0.001, <0.001) and DSS (p=0.015, 0.009, <0.001). Two-step multivariate Cox regression confirmed the enhanced predictive performance of the modified lymph node staging system. The new ypTNM system stratified patients into 6 subgroups (ypCR, I-IIIB), demonstrating improved accuracy (C-index, OS 0.694 versus [vs.] 0.647; DSS, 0.696 vs. 0.650; both p<0.001), model fit (lower Akaike information criterion/Bayesian information criterion), clinical utility (Net reclassification index, 38.62%/37.80%; integrated discrimination improvement, 7.60%/7.20%), and stability (time-dependent receiver operating characteristic curve). External validation (n = 1637) confirmed its superiority (all p<0.05). CONCLUSION:This internationally validated modified ypTNM system, based on optimized lymph node staging, outperformed the AJCC 8th Edition in terms of prognostic accuracy for patients diagnosed with GC post-NAT, offering a more precise tool for clinical decision making.

BACKGROUND:In recent years, the use of laparoscopic techniques in total gastrectomy has gradually increased. Strong evidence is urgently needed to confirm the long-term oncological outcomes of laparoscopic-assisted total gastrectomy for resectable gastric cancer. METHODS:The training set contained 811 gastric cancer patients from Fujian Medical University Union Hospital, and 267 gastric cancer patients in Putian University Affiliated Hospital were used as an external validation set. A minimum P value approach was used to evaluate the optimal threshold of recurrence-free survival to divide the patients into early and late recurrence cohorts based on the length of the postrecurrence survival. RESULTS:The training set had a 5-year actual overall survival rate of 62.5% and a 5-year actual recurrence-free survival rate of 60.3%. Of the 811 patients, 324 (40.0%) experienced recurrence, with the highest percentage of distant metastases (n = 199; 61.4%). Univariate and multivariate Cox regression analyses showed that pT stage, pN stage, nerve/lymphatic invasion, preoperative carcinoembryonic antigen, preoperative immunoinflammatory index (systemic immune-inflammatory index), and postoperative adjuvant chemotherapy were independent prognostic factors associated with overall survival and recurrence-free survival (all P < .05). The optimal cutoff time for distinguishing between early recurrence (n = 113; 34.9%) and late recurrence (n = 211; 65.1%) was the 12th postoperative month (P = .011). Factors associated with early recurrence included pT stage, pN stage, preoperative cancer antigen 72-4, cancer antigen 199, cancer antigen 125, and systemic immune-inflammatory index, based on which we constructed an early recurrence prediction model. The predictive evaluation indices of this model were significantly better than those of the American Joint Committee on Cancer Eighth Edition pTNM staging system; these results were also found in the external validation cohort. CONCLUSION:In this retrospective analysis, we found that laparoscopic-assisted total gastrectomy in patients with resectable gastric cancer had good long-term oncological outcomes, with an optimal cutoff time of 12 months postoperatively for early recurrence and late recurrence after laparoscopic-assisted total gastrectomy. The early recurrence prediction model constructed for patients with laparoscopic-assisted total gastrectomy may inform clinicians to develop more precise treatment and follow-up strategies.

Visceral obesity has been increasingly recognized as a potential risk factor for surgical complications in gastric cancer surgery, yet its impact on lymphadenectomy during laparoscopic gastrectomy remains undefined. This study aimed to investigate the influence of visceral fat area (VFA) on intraoperative adverse events (iAEs) during lymphadenectomy in laparoscopic gastrectomy. A post hoc analysis was performed using data from two previous prospective studies ([NCT02327481] and [NCT01609309]). The patients were divided into high and low VFA groups based on preoperative computed tomography images at the umbilical level. All iAEs were reviewed from the surgical videos and graded using ClassIntra. The factors influencing iAEs were identified, and predictive models for iAEs were constructed. This study included 490 patients, with 244 and 246 patients in the high and low VFA groups, respectively. Restricted cubic splines demonstrated a positive linear association between VFA and iAEs. Compared with the low VFA group, the high VFA group exhibited a significantly higher incidence of iAEs (29

Conventional ypT category evaluates the depth of invasion after neoadjuvant therapy (NAT) for gastric cancer (GC) and has limited prognostic value. Tumor regression grade (TRG) measures the extent of tumor response to treatment, and when combined with the ypN category, it may enhance the prediction of patient outcomes. This study aims to develop a new staging system by integrating TRG and ypN category to better evaluate the prognosis of GC patients receiving NAT. This retrospective analysis included 962 patients who underwent radical gastrectomy after NAT, with 513 in the development cohort (from one center) and 449 in the external validation cohort (from five centers). The ypN-TRG staging system was established by calculating the distance from the origin on a cartesian plane incorporating the ypN (x-axis) stage and TRG (y-axis) grade, and five sub-stages were delineated. In the development cohort, 3-year overall survival rates according to ypN-TRG stage I, IIA, IIB, IIIA, IIB were 87.6

BACKGROUND AND OBJECTIVE:To compare the technical performances and short- and long-term outcomes of laparoscopic total gastrectomy for remnant gastric cancer and primary upper gastric cancer. METHODS:This prospective study (FUGES-004 study) enrolled 50 remnant gastric cancer patients who underwent laparoscopic total gastrectomy at Fujian Medical University Union Hospital between June 2016 and June 2020 (ClinicalTrials.gov identifier: NCT02792881). Propensity score matching (1:2) was used to select upper gastric cancer patients who underwent laparoscopic total gastrectomy in the FUGES-001 and FUGES-002 studies. Technical performance was assessed using the General Error Reporting Tool, Objective Structured Assessment of Technical Skills (OSATS), and Intraoperative Complication Classification. RESULTS:After matching, 46 remnant gastric cancer and 92 upper gastric cancer patients were included in the final analysis. Abdominal adhesions in the epigastrium, central abdomen, and bowel-to-bowel regions were more severe in the remnant gastric cancer group (P < .001). The remnant gastric cancer group had more technical errors and intraoperative adverse events (especially grade I bleeding) during surgery (P < .05). However, the Objective Structured Assessment of Technical Skills scores were comparable between the remnant gastric cancer and upper gastric cancer groups (30.8 vs 31.0, P = .799). Although the severe postoperative complication rates were similar between the 2 groups (P = .333), the postoperative complication rate was significantly higher in the remnant gastric cancer group (28.3% vs 7.6%, P = .001). Additionally, the long-term oncologic outcomes (including 3-year disease-free survival, overall survival, and recurrence pattern) were comparable between the remnant gastric cancer and upper gastric cancer groups (log-rank P > .05). CONCLUSIONS:Although the long-term oncologic outcomes were comparable between the groups, the remnant gastric cancer group had more intraoperative errors and adverse events and higher postoperative complication rates than the upper gastric cancer group. For complex remnant gastric cancer cases, laparoscopic total gastrectomy may serve as an effective therapeutic option. However, experienced surgeons at high-volume centers should exercise caution when performing laparoscopic total gastrectomy and implement more rigorous perioperative management strategies.

We report the short-term results of indocyanine green (ICG)-guided laparoscopic lymphadenectomy for gastric cancer (GC). The primary outcome is 3-year disease-free survival. In this analysis, we present short-term secondary outcomes focused on the number of lymph nodes (LNs) retrieved and the diagnostic value of fluorescent status for metastatic LNs, excluding long-term outcomes. A total of 1,006 patients are included in the per-protocol analysis. The mean number of LNs retrieved in the ICG group is significantly higher than that in the non-ICG group. The negative predictive value is 93.9% for nonfluorescent stations, and the sensitivity of ICG for detecting all metastatic LN stations is 91.6%. ICG technology is safe and feasible for laparoscopic lymphadenectomy in GC and can noticeably increase the number of LNs retrieved. Further follow-up is necessary to warrant whether ICG can improve long-term survival of GC. The Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS)-11 trial has been registered at ClinicalTrials.gov as NCT04593615.

Background:Previous studies have demonstrated similar short-term efficacy between subserosal (SSA) and submucosal (SMA) approaches for ICG injection in gastric cancer (GC). This study aims to compare the long-term oncological outcomes of these two injection methods for lymph node (LN) tracing in ICG-guided laparoscopic gastrectomy.Materials and methods:This study was a phase 3, open-label, randomized clinical trial (FUGES-019). A total of 266 patients with resectable gastric adenocarcinoma (cT1-4a, N0/ +, M0) were enrolled. We report predefined long-term secondary outcomes, including three-year actual overall survival (OS), three-year actual disease-free survival (DFS), and recurrence patterns.Results:Of the 266 participants, 259 patients were included in the per-protocol analysis: 129 in the SSA group and 130 in the SMA group. The actual OS in the SSA group (87.6%) was comparable to that in the SMA group (90.8%, P = 0.41), as were the 3-year actual DFS rates (SSA: 82.9% vs. SMA: 88.5%, log-rank P = 0.19). Per-protocol analysis confirmed the equivalence of the SSA compared with the SMA. The most common type of recurrence was multiple site metastasis (11 of 259[4.24%]), with no differences in recurrence types across cancer stages. Further stratified analysis based on pT, pN staging, tumor size, and BMI showed no significant differences between the two groups.ConclusionThe 3-year outcomes of the FUGES-019 trial confirm the equivalence of SSA and SMA in ICG-guided laparoscopic lymphadenectomy for GC, supporting the previous short-term findings. The subserosal approach can be recommended for ICG administration based on clinical considerations.

The clinical use of indocyanine green (ICG) in laparoscopic radical gastrectomy for gastric cancer remains at an exploratory stage. Participants with resectable gastric adenocarcinoma were randomly allocated in a 1:1 ratio. The primary outcome is the number of retrieved lymph nodes (LNs) and has been reported. Herein, we report the 5-year overall survival (OS) rate, 5-year disease-free survival (DFS) rate, and related recurrence patterns. Total 258 patients (ICG group, 129; non-ICG group, 129) were included in the final per-protocol analysis. The 5-year OS and DFS rate of the ICG group were superior to those of the non-ICG group (all log-rank P < 0.05). After a 5-year follow-up, the ICG group had a considerably lower cumulative recurrence rate (26/129, 20.2

Background:Restrictive cardiomyopathy (RCM) is a relatively rare cardiomyopathy. We report a case of familial restrictive cardiomyopathy confirmed by myocardial biopsy and genetic testing. Case summary:A 19-year-old male presented with recurrent syncope and cardiac arrest episodes over 1 year. Genetic testing identified a novel heterozygous insertion mutation (c.2489_2490insTTGCT, p.Q830Hfs*73) in the ACTN2 gene, altering a highly conserved amino acid sequence. Immunohistochemical analysis of endomyocardial biopsies revealed significantly elevated ACTN2 protein expression (77.34% positivity, H-Score 132.14). This mutation represents a likely pathogenic variant accounting for sudden cardiac deaths in multiple male family members. Discussion:Restrictive cardiomyopathy has a rigid, noncompliant left ventricle, and left ventricular systolic function is usually preserved in the early stages of RCM but tends to deteriorate over time. In this case, the only adaptive response that can increase cardiac output is an increase in the heart rate, which may be attenuated in patients with concomitant autonomic dysfunction, thereby increasing the risk of hypotension during exercise. Therefore, hypotension due to decreased left cardiac output may have been the main cause of post-exercise syncope in this case.In this report, we used whole-exome sequencing to identify a mutation in the ACTN2 gene of this RCM patient. Subsequently, we performed a one-generation validation in his mother and his brother and analysed the correlation between this gene variant and the RCM phenotype. This may be helpful for early identification and diagnosis of RCM.

Background Evidence based on large-scale samples comparing the efficacy of laparoscopic gastrectomy (LG) and open gastrectomy (OG) in patients with locally advanced gastric cancer (LAGC) after neoadjuvant chemotherapy (NACT) remains limited. This multicenter study aimed to evaluate the short -term and oncological outcomes of LG and OG after NACT. Methods Data from a multicenter database of LAGC patients undergoing radical gastrectomy after NACT across 12 centers in China. Propensity score matching (PSM 3:1) was used to balance baseline characteristics. Short-term outcomes, 5-year overall survival (OS), disease-free survival (DFS), and recurrence patterns were compared. Results In total, 962 patients fulfilled the inclusion criteria, of whom 753 underwent LG and 209 underwent OG. After PSM, 627 LG and 209 OG patients were analyzed. Both groups had comparable clinical and pathological characteristics (SMD≤0.100). Intraoperative blood loss was lower in the LG group, with earlier ambulation and diet initiation than that in the OG group (P < 0.05). The number of lymph nodes retrieved was higher in LG group (P < 0.001). Although no significant differences were shown in 5-year OS (LG vs. OG: 51.7vs.43.4 %) and 5-year DFS (LG vs. OG, 48.8 vs. 41.4 %; P > 0.05), landmark analysis revealed improved OS (77.6vs. 65.9 %; P = 0.024) and DFS (84.1vs.71.4 %; P = 0.031) after a landmark time of 28 months in the LG group. Most recurrences occurred within 3 years postoperatively, with similar recurrence patterns in both groups (P > 0.05). Conclusions In LAGC patients after NACT, LG yielded faster recovery while demonstrating comparable surgical efficacy and oncological outcomes to OG, with potential long-term survival benefits.

Castration-resistant prostate cancer (CRPC) presents a significant challenge in treatment following androgen deprivation therapy. This study evaluates Trillin, a compound with antioxidant and anti-inflammatory properties, for its therapeutic potential against CRPC. Using DU145 and PC3 cell lines and a mouse xenograft model, we demonstrate that Trillin effectively inhibits CRPC cell viability, proliferation, migration, and invasion while promoting apoptosis and cell cycle arrest. Mechanistic investigations reveal that Trillin disrupts NF-κB/COX-2 signaling by downregulating MAP3K11 and COX-2 and inhibiting the nuclear translocation of NF-κB subunits. Additionally, Trillin enhances the expression of miR-145-5p, further modulating pathways critical for CRPC progression. These findings suggest that Trillin may offer a promising alternative approach for targeting CRPC, highlighting its potential as a therapeutic agent to improve patient outcomes.

Kidney diseases, particularly chronic kidney disease (CKD), represent a significant health concern, particularly as one ages. This paper delves into an in-depth analysis of CKD, exploring its prevalence, risk factors, and the complex interplay of conventional and nontraditional determinants. Notably, socioeconomic, genetic, and lifestyle factors are pivotal in understanding CKD's multifaceted etiology. The research employs a diverse dataset from Bangladesh, applying statistical techniques including ANOVA, logistic regression, recursive feature elimination, and random forest to identify and evaluate crucial factors associated with CKD. The study aims to construct a robust predictive model for CKD risk assessment, integrating traditional and lesser-explored variables. This comprehensive approach holds promise in refining risk assessment models and guiding targeted intervention strategies for enhanced CKD prevention and management. The findings emphasize the necessity for a holistic understanding of CKD, emphasizing personalized approaches for effective disease management and prevention.

Textbook outcome (TO) is widely recognized as a comprehensive prognostic indication for patients with gastric cancer (GC). This study aims to develop a modified TO (mTO) for elderly patients with GC. Data from the elderly patients (aged ≥ 65 years) in two Chinese tertiary referral hospitals were analyzed. 1389 patients from Fujian Medical University Union Hospital were assigned as the training cohort and 185 patients from Affiliated Hospital of Putian University as the validation cohort. Nomogram was developed by the independent prognostic factors of Overall Survival (OS) based on Cox regression. In the training cohort, laparoscopic surgery was significantly correlated with higher TO rate (P < 0.05). Cox regression analysis revealed that surgical approach was also an independent factor of OS (P < 0.001), distinct from the traditional TO. In light of these findings, TO parameters were enhanced by the inclusion of surgical approach, rendering a modified TO (mTO). Further analysis showed that mTO, tumor size, pTNM staging, and adjuvant chemotherapy were independent prognostic factors associated with OS (all P < 0.05). Additionally, the nomogram incorporating these four indicators accurately predicted 1-, 3-, and 5-year OS in the training cohort, with AUC values of 0.793, 0.814, and 0.807, respectively, and exhibited outstanding predictive performance within the validation cohort. mTO holds a robust association with the prognosis of elderly patients with GC, meriting intensified attention in efforts aimed at enhancing surgical quality. Furthermore, the predictive model incorporating mTO demonstrates excellent predictive performance for elderly patients with GC.

Background Malnutrition and inflammation can affect the prognosis of patients with gastric cancer (GC). This study aimed to explore the value of fat-free mass index (FFMI) combined with the neutrophil–lymphocyte ratio (NLR) on the short- and long-term outcomes of patients with GC. Methods We retrospectively analyzed 1603 patients with GC in at a tertiary referral teaching hospital between 2016 and 2019. Patients in the 1st quartile of FFMI were defined as the low FFMI group and the remaining patients as the normal FFMI group, according to sex-specific quartiles. Patients were divided into high and low NLR groups according to the median NLR. Patients with a low FFMI/high NLR were defined as the high-risk group, and the remaining patients were defined as the low-risk group. Results The postoperative recovery time of the high-risk group was significantly longer than that of the low-risk group (all P <0.05). Logistic regression analysis indicated that FNC could independently predict postoperative anastomotic leakage (OR=2.16, 95% CI: 1.03–4.54, P=0.041). The high-risk group had much worse 3-y overall survival (64.7% vs. 79.4%; P<0.001) and 3-y disease-free survival (62.8% vs. 78.6%; P<0.001) than the low-risk group. Multivariate Cox analysis showed that FNC was an independent prognostic factor for patients with GC (HR=1.54, 95% CI: 1.22–1.94, P<0.001). Further stratified analysis based on tumor stage showed that the high-risk group did not benefit from postoperative adjuvant chemotherapy. Conclusions FFMI combined with NLR can predict postoperative short- and long-term outcomes in patients with GC.

Laparoscopy-assisted gastrectomy (LG) is rapidly gaining popularity owing to its minimal invasiveness. Previous studies have found that compared with two-dimensional (2D)-LG, three-dimensional (3D)-LG showed better short-term outcomes. However, the long-term oncological outcomes in patients with locally resectable gastric cancer (GC) remain controversial. In this noninferiority, open-label, randomized clinical trial, a total of 438 eligible GC participants were randomly assigned in a 1:1 ratio to either 3D-LG or 2D-LG from January 2015 to April 2016. The primary endpoint was operating time, while the secondary endpoints included 5-year overall survival (OS), disease-free survival (DFS), and recurrence pattern. Data from 401 participants were included in the per-protocol analysis, with 204 patients in the 3D group and 197 patients in the 2D group. The 5-year OS and DFS rates were comparable between the 3D and 2D groups (5-year OS: 70.6 http://clinicaltrials.gov ).

Sarcopenic obesity may affect the health outcome of people with obesity after laparoscopic sleeve gastrectomy (LSG). To assess the impact of sarcopenic obesity (SO) on weight loss outcomes and improvement of quality of life after LSG. This observational study included patients who underwent LSG with SO (99 patients) or without SO (146 patients) from a single center. The primary endpoint was weight loss and disease-specific quality of life in patients with or without SO after the operation. Fat-free mass (FFM) and fat mass (FM) were calculated based on the L3-level images of preoperative CT scans. SO was diagnosed if FM/FFM ≥ 0.80. Operative time and postoperative hospital stay days were longer in the SO group (p < 0.001). After LSG, weight, BMI, and EBMI were significantly lower in the NSO group than in the SO group (all P < 0.05), while

Background:The triglyceride-glucose (TYG) index is a novel and reliable marker reflecting insulin resistance. Its predictive ability for cardiovascular disease onset and prognosis has been confirmed. However, for advanced chronic heart failure (acHF) patients, the prognostic value of TYG is challenged due to the often accompanying renal dysfunction (RD). Therefore, this study focuses on patients with aHF accompanied by RD to investigate the predictive value of the TYG index for their prognosis.Methods and Results:717 acHF with RD patients were included. The acHF diagnosis was based on the 2021 ESC criteria for acHF. RD was defined as the eGFR < 90 mL/(min/1.73 m2). Patients were divided into two groups based on their TYG index values. The primary endpoint was major adverse cardiovascular events (MACEs), and the secondary endpoints is all-cause mortality (ACM). The follow-up duration was 21.58 (17.98-25.39) months. The optimal cutoff values for predicting MACEs and ACM were determined using ROC curves. Hazard factors for MACEs and ACM were revealed through univariate and multivariate COX regression analyses. According to the univariate COX regression analysis, high TyG index was identified as a risk factor for MACEs (hazard ratio = 5.198; 95% confidence interval [CI], 3.702-7.298; P < 0.001) and ACM (hazard ratio = 4.461; 95% CI, 2.962-6.718; P < 0.001). The multivariate COX regression analysis showed that patients in the high TyG group experienced 440.2% MACEs risk increase (95% CI, 3.771-7.739; P < 0.001) and 406.2% ACM risk increase (95% CI, 3.268-7.839; P < 0.001). Kaplan-Meier survival analysis revealed that patients with high TyG index levels had an elevated risk of experiencing MACEs and ACM within 30 months.Conclusion:This study found that patients with high TYG index had an increased risk of MACEs and ACM, and the TYG index can serve as an independent predictor for prognosis.

BACKGROUND:Robotic gastrectomy is a safe and feasible approach for gastric cancer (GC); however, its long-term oncological efficacy remains unclear. The authors evaluated the long-term survival outcomes and recurrence patterns of patients with locally advanced proximal GC who underwent robotic total gastrectomy (RTG). METHODS:This prospective study (FUGES-014 study) enrolled 48 patients with locally advanced proximal GC who underwent RTG between March 2018 and February 2020 at a tertiary referral teaching hospital. Patients who underwent laparoscopic total gastrectomy (LTG) in the FUGES-002 study were enrolled in a 2:1 ratio to compare the survival outcomes between RTG and LTG. The primary endpoint of the FUGES-014 study was postoperative 30-day morbidity and has been previously reported. Here, the authors reported the results of 3-year disease-free survival (DFS), 3-year overall survival (OS), and recurrence patterns. RESULTS:After propensity score matching, 48 patients in the RTG and 96 patients in the LTG groups were included. The 3-year DFS rates were 77.1% (95% CI: 66.1-89.9%) for the RTG and 68.8% (95% CI: 60.1-78.7%) for the LTG groups ( P =0.261). The 3-year OS rates were not significantly different between the groups (85.4 vs. 74.0%, P =0.122). Recurrence occurred in nine patients (18.8%) in the RTG and 27 (28.1%) patients in the LTG groups ( P =0.234). Recurrence patterns and causes of death were similar between the groups ( P >0.05). CONCLUSIONS:The oncological outcome of RTG was noninferior to that of LTG. Thus, RTG might be an alternative surgical treatment for locally advanced proximal GC.

Background Surgical quality control is a crucial determinant of evaluating the tumor efficacy. Objective To assess the ClassIntra grade for quality control and oncological outcomes of robotic radical surgery for gastric cancer (GC). Methods Data of patients undergoing robotic radical surgery for GC at a high-volume center were retrospectively analyzed. Patients were categorized into two groups, the intraoperative adverse event (iAE) group and the non-iAE group, based on the occurrence of intraoperative adverse events. The iAEs were further classified into five sublevels (ranging from I to V according to severity) based on the ClassIntra grade. Surgical performance was assessed using the Objective Structured Assessment of Technical Skill (OSATS) and the General Error Reporting Tool. Results This study included 366 patients (iAE group: n = 72 [19.7%] and non-iAE group: n = 294 [80.3%]). The proportion of ClassIntra grade II patients was the highest in the iAE group (54.2%). In total and distal gastrectomies, iAEs occurred most frequently in the suprapancreatic area (50.0% and 54.8%, respectively). In total gastrectomy, grade IV iAEs were most common during lymph node dissection in the splenic hilum area (once for bleeding [grade IV] and once for injury [grade IV]). The overall survival (OS) and disease-free survival of the non-iAE group were significantly better than those of the iAE group (Log rank P < 0.001). Uni- and multi-variate analyses showed that iAEs were key prognostic indicators, independent of tumor stage and adjuvant chemotherapy ( P < 0.001). Conclusion iAEs in patients who underwent robotic radical gastrectomy significantly correlated with the occurrence of postoperative complications and a poor long-term prognosis. Therefore, utilization and inclusion of ClassIntra grading as a crucial surgical quality control and prognostic indicator in the routine surgical quality evaluation system are recommended.