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  Locally Advanced Gastric Cancer Definition Locally advanced gastric cancer invades beyond the submucosa, regardless of lymphatic metastases. Ethicon Laparoscopic Trainer. During their internship in laparoscopic technique, many of them have not received practical training with Ethicon Laparoscopic Trainer . This type of cancer requires D2 lymphadenectomy. And unlike lymphadenectomy, it requires dissection of the lymphatic groups that are around larger vessels. Such as the hepatic artery, splenic artery, and the portal vein. In the latest guidelines, the lymphatic group of the splenic hilum eliminates from the definition of D2 dissection. Due to the limitations of laparoscopy regarding the visibility of these lesions, currently, the surgery of choice for patients with locally advanced gastric cancer is open gastrectomy with lymphadenectomy. Gaining experience with laparoscopic gastrectomy in early gastric cancer, surgeons started with the laparoscopic approach for loca...