Feasibility Study of Laparoscopy-assisted D2 Distal Gastrectomy to Treat Advanced Gastric Cancer

Inclusion Criteria: * histologically proven primary gastric adenocarcinoma * T2 or T3 or T4a, N0 or N1 or N2 or N3a (AJCC 7th), which is assessed by computed tomography (CT) scan - mid 1/3 or low 1/3 location * No evidence of other distant metastasis * not stump carcinoma,(vi) aged 20-80 year old * performance status (PS) of 0 or 1 on Eastern Cooperative Oncology Group (ECOG) scale * no prior treatment of chemotherapy or radiation therapy against any other malignancies, and no prior treatment for gastric cancer including endoscopic mucosal resection * adequate organ functions defined as indicated below: * WBC 3000/mm3, WBC 12 000/mm3 * Hb 8.0 g/dl without any transfusion 2 weeks before enrollment * Plt 100 000/mm3 * AST 100 IU/l * ALT 100 IU/l * T.Bil 2.0 mg/dl * written informed consent Exclusion Criteria: * active double cancer (synchronous double cancer and metachronous double cancer within five disease-free years), excluding carcinoma in situ (lesions equal to intraepithelial or intramucosal cancer) * pregnant or breast-feeding women * severe mental disorder * systemic administration of corticosteroids * unstable angina or myocardial infarction within 6 months of the trial * unstable hypertension * severe respiratory disease requiring continuous oxygen therapy * previous upper abdominal surgery except laparoscopic cholecystectomy