Gastrectomy with D2 lymph node (LN) dissection is considered as a standard operation for advanced gastric cancer for locally advanced gastric cancer. Prophylactic para-aortic LN dissection is not recommended according to the results of JCOG 9501. However, the role of extended surgery including para-aortic LN dissection in patients with positive nodal involvement in para-arotic area is another issue. In addition, pre-operative chemotherapy is considered to be a promising strategy for patients with marginally resectable tumors. Although the optimal extent of surgery for these patients is still undetermined, surgery should be considered if R0 resection can be performed. Careful selection of patients and safe and secure surgery is necessary in order to achieve R0 resection without surgical complications.
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