简介：Baseduponstudiesfromrandomizedclinicaltrials,theextended(D2)lymphnodedissectionisnowrecommendedasastandardprocedureforlocaladvancedgastriccancerworldwide.However,therationalextentlymphadenectomyforlocaladvancedgastriccancerhasremainedatopicofdebateinthepastdecades.Duetothelimitationoflowmetastaticrateinpara-aorticnodes(PAN)inJCOG9501,theclinicalbenefitofD2+para-aorticnodaldissection(PAND)forpatientswithstageT4and/orstageN3disease,whichisverycommoninChinaandothercountriesexceptJapanandKorea,cannotbedetermined.Furthermore,theroleofsplenectomyforcompleteresectionofNo.10andNo.11nodeshasbeencontroversial,andhowever,thefinalresultsfromtherandomizedtrialofJCOG0110haveyettobecompleted.GastriccancerwiththeNo.14andNo.13lymphnodemetastasisisdefinedasM1stageinthecurrentversionoftheJapaneseclassification.WeproposethatD2+No.14vand+No.13lymphadenectomymaybeanoptioninapotentiallycurativegastrectomyfortumorswithapparentmetastasistotheNo.6nodesorinfiltratetoduodenum.Theexaminedlymphnodeandextranodalmetastasisaresignificantlyassociatedwiththesurvivalofgastriccancerpatients.