{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:49:12Z","timestamp":1786978152461,"version":"build-2736575974"},"reference-count":55,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Robotic surgery for gastric adenocarcinoma (GC) shows recovery benefits compared to open and laparoscopic approaches. While open conversion (OC) is associated with poorer outcomes, factors influencing robotic gastrectomy (RG) OC are obscure. We identified preoperative and intraoperative risk factors for OC and associated outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective analysis of RG using a prospectively maintained GC database from a high\u2010volume comprehensive US cancer center between January 2010 and October 2022. RG standardization began in July 2015, with ongoing expansion of patient selection criteria. Patients who underwent radical resection with biopsy\u2010proved GC were included in the analysis if the operation was initiated robotically. Preoperative documentation of likely to convert to open procedures was identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 289 gastrectomy cases, 133 (46.0%) were RG. Before RG standardization, OC rate was 42.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098\/19); then decreased to 15.8% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918\/114). Factors causing unplanned OC included instability upon insufflation (7.7%), difficult esophagojejunostomy (23.1%), bulky nodes (26.9%), and tumor invasion\/fibrosis (38.5%). On multivariate analysis, Preoperative EUS (OR 0.78) decreased OC likelihood, whereas prior abdominal surgeries (OR 1.31) increased OC likelihood (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). D2 lymphadenectomy and neoadjuvant treatment did not increase OC likelihood.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pre\u2010operatively identifiable OC factors can guide RG patient selection. Yet, certain intraoperative findings challenge RG and require improved preoperative planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70032","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T12:45:14Z","timestamp":1752151514000},"page":"503-513","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk of Open Conversion During Robotic Gastrectomy for Gastric Cancer: Optimizing Patient Selection"],"prefix":"10.1002","volume":"132","author":[{"given":"Courtney","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"},{"name":"Department of Surgery Cedars Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars Sinai Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Lau","sequence":"additional","affiliation":[{"name":"Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Mahuron","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuhei","family":"Aoyama","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology City of Hope National Medical Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradford","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6279-7981","authenticated-orcid":false,"given":"Laleh","family":"Melstrom","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. Benjamin","family":"Paz","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8934-9959","authenticated-orcid":false,"given":"Yuman","family":"Fong","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanghee","family":"Woo","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery City of Hope Comprehensive Cancer Center Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"issue":"9","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1200\/JCO.20.01540","article-title":"Laparoscopic Versus Open Gastrectomy for Gastric Cancer (LOGICA): A Multicenter Randomized Clinical Trial","volume":"39","author":"Veen A.","year":"2021","journal-title":"Journal of Clinical Oncology"},{"issue":"1","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1001\/jamasurg.2021.5104","article-title":"Laparoscopic Vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer: Five\u2010Year Outcomes From the CLASS\u201001 Randomized Clinical Trial","volume":"157","author":"Huang C.","year":"2022","journal-title":"JAMA Surgery"},{"issue":"10","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1001\/jamaoncol.2020.3152","article-title":"Morbidity and Mortality of Laparoscopic Vs Open Total Gastrectomy for Clinical Stage I Gastric Cancer: The CLASS02 Multicenter Randomized Clinical Trial","volume":"6","author":"Liu F.","year":"2020","journal-title":"JAMA Oncology"},{"issue":"7","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1245\/s10434-017-5851-1","article-title":"Surgical Outcomes After Open, Laparoscopic, and Robotic Gastrectomy for Gastric Cancer","volume":"24","author":"Yang S. 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