“…Thus, we used the 18% complication rate as the comparative historical control. To calculate the limitation of non-inferiority, we collected 16 studies on complications after open total gastrectomy published in English for the past 10 years and conducted a metaanalysis [8,9,13,[15][16][17][18][19][20][21][22][23][24][25][26][27]. As a result, the 95% confidence interval of the upper limit was determined to be 26.6%, and Additional treatments were required, such as catheter re-insertion due to dysuria and urinary retention Cardiac Treatments were required due to symptoms of heart failure after surgery, myocardial ischemia, or infarction Systemic infection Symptoms of fever due to infection, increased number of neutrophils, and pathogen cultures from a blood culture examination Local complications Wound Extended hospitalization due to surgical wound infection and additional treatment other than simple disinfection was required Ascites Additional treatments were required due to retention of intraperitoneal fluid or abdominal distension after an abdominal ultrasound examination or tomography Postoperative ileus Fasting more than 7 days after surgery due to enteroplegia or drainage that occurred through the nasogastric tube Abdominal abscess Intra-abdominal abscesses or infected body fluids were found after an abdominal ultrasound examination or tomography such that the additional use of antibiotics or additional treatment was required, such as drainage or reoperation Pancreatic leakage Amylase level in peritoneal fluid discharged through the drainage tube was > 1,000 IU, protein ≥ 3.0 g/dL: amylase and protein levels in peritoneal fluid discharged through the drainage tube were routinely measured on postoperative day 4 Acute pancreatitis Symptoms, such as abdominal pain or fever after surgery, accompanied by abdominal CT results or blood amylase levels greater than three times the normal level Intra-abdominal bleeding Bleeding through the drainage tube installed inside the abdominal cavity and additional treatments required, such as blood transfusion, reoperation, and embolization due to bleeding, confirmed through imaging tests accompanied by a decrease in serum hemoglobin Anastomotic bleeding Additional treatments required, such as transfusion, endoscopic surgery, and reoperation, due to a decrease in plasma hemoglobin level caused by anastomotic bleeding confirmed through endoscopy Anastomotic stenosis Fasting or drainage, endoscopic intervention, and reoperation required due to food discharge difficulties below the anastomotic site after surgery Anastomotic leakage…”