Laparoscopic gastrectomy for locally advanced gastric cancer (GC) has been applied more frequently, especially in East Asia. The advantages of laparoscopic distal gastrectomy (LDG) over open distal gastrectomy (ODG) have been shown in some studies.
1,2 However, the effectiveness of LDG for T4a GC is still questioned due to large tumors, high rate of lymph node metastasis, peritoneal seeding of malignant cells, and perioperative complications. Although some studies have demonstrated the safety and short-term benefits of LDG for pT4a GC, evidence is still inadequate, particularly for long-term oncologic outcomes.
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