Gastric adenocarcinoma is a complex disease that requires a thorough multidisciplinary approach for appropriate management. Management strategies vary in different regions of the world and have changed over time. In spite of improvements in chemotherapy and surgical techniques and an improvement in outcomes over the last several decades, overall survival remains low. The best outcomes are likely related to early detection, preoperative reduction of tumor burden with immunochemotherapy, consistent surgical technique for resection, and postoperative eradication of tumor cells. We aim to describe the management for gastric cancer, from the specifics of staging and imaging workup to the tenets of surgical resection and reconstruction as well as the adjuvant treatment strategies in this broad review of gastric cancer management.

Background: We aim to evaluate how new robotic skills are acquired and retained by having participants train and retest using exercises on the robotic platform. We hypothesized that participants with a 3month break from the robotic platform will have less learning decay and increased retention compared with those with a 6-month break.Methods: This was a prospective randomized trial in which participants voluntarily enrolled and completed an initial training phase to reach proficiency in 9 robot simulator exercises. They were then instructed to refrain from practicing until they retested either 3 or 6 months later. This study was completed at an academic medical center within the general surgery department. Participants were medical students, and junior-level residents with minimal experience in robotic surgery were enrolled. A total of 27 enrolled, and 13 participants completed the study due to attrition.Results: Overall, intragroup analysis revealed that participants performed better in their retest phase compared with their initial training in terms of attempts to reach proficiency, time for completion, penalty score, and overall score. Specifically, during the first attempt in the retesting phase, the 3-month group did not deviate far from their final attempt in the training phase, whereas the 6-month group experienced significantly worse time to complete and overall score in interrupted suturing {[−4 (−18 to 20) seconds vs. 109 (55 to 118) seconds, P = 0.02] [−1.3 (−8 to 1.9) vs. −18.9 (−19.5 to (−15.0)], P = 0.04} and 3-arm relay {[3 (−4 to 23) seconds vs. 43 (30 to 50) seconds, P = 0.02] [0.4 (−4.6 to 3.1) vs. −24.8 (−30.6 to (−20.3)], P = 0.01] exercises. In addition, the 6month group had a significant increase in penalty score in retesting compared with the 3-month group, which performed similarly to their training phase [3.3 (2.7 to 3.3) vs. 0 (−0.8 to 1.7), P = 0.03].Conclusions: This study identified statistically significant differences in learning decay, skills retention, and proficiency between 3-month and 6-month retesting intervals on a robotic simulation platform.

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