Strategy of laparoscopic suprapancreatic lymph node dissection for advanced gastric cancer

The lymph nodes (LNs) that distribute along the celiac artery (CA) system in the suprapancreatic area include LNs around the root of the left gastric vessels (No. 7, No. 8a, No. 9 and No. 11p) and the right gastric vessels (No. 5 and No. 12a). Due to the high rate of LNs metastasis and the various vascular anatomies in this area, the suprapancreatic LN dissection is a crucial and demanding procedure for radical resection in the treatment of patients with advanced gastric cancer (AGC). Laparoscopic gastrectomy with D2 LN dissection has not yet been widely adopted for advanced stages because it is technically complicated. The initial segment of the splenic artery (SpA) approach is recommended as the ideal approach for laparoscopic suprapancreatic LN dissection in AGC.