Gastric cancer is one of the most prevalent malignant tumors in China and around the world, and its incidence and mortality rate still rank among the top three malignant tumors up to now. In East Asia, Japan, Korea and China are the regions with high incidence of gastric cancer, but their incidence characteristics are different. Generally speaking, the rate of early gastric cancer is higher in Japan and Korea, accounting for more than 60% of diagnosed gastric cancer patients. However, in China, the figure is below 5%, and almost all patients diagnosed with gastric cancer are in the progressive stage of gastric cancer, and some of them even have tumor spread at the time of diagnosis, making radical surgery impossible, and the prognosis is poor. Therefore, the situation of gastric cancer treatment in China is still very serious. Today, with the rapid development of medical technology, surgery is still the only possible way to cure stomach cancer. Other adjuvant treatments, including chemotherapy, radiotherapy, interventional therapy, etc., although they have been updated and advanced to a certain extent, can only delay the progress of the disease to a lesser extent, but cannot achieve the purpose of cure. Since 1881, when Professor Billroth of the University of Vienna, Austria, performed the first gastric cancer surgery in the world, gastric cancer surgery has changed a lot in more than 100 years with the development of science and technology and the doctors’ deepening understanding of such diseases. After entering the 21st century, the D2 radical surgery (total gastrectomy or distal gastrectomy + lymph node dissection at station 1 and 2) for gastric cancer has been gradually established as the standard surgical procedure for resectable progressive gastric cancer, which has greatly improved the overall survival rate and disease-free survival rate of gastric cancer patients through the continuous exploration of many gastrointestinal surgery experts and scholars across China. Traditionally, gastric cancer surgery is done on the basis of open surgery. Clear visualization and ease of operation are among its advantages. However, a long abdominal incision is usually required for such surgery, which is more than 500 px in almost all patients and even 750 px in some patients, resulting in greater surgical trauma, slower postoperative recovery and poorer short-term postoperative quality of life. Laparoscopic technique is an emerging surgical technique developed on the basis of open surgery, which is characterized by less trauma, less intraoperative bleeding, better perioperative patient quality of life, and faster postoperative recovery, etc. It is soon accepted by a large number of surgeons and scholars worldwide. Laparoscopy was initially (1990~2000) mainly applied to the surgical treatment of benign diseases (laparoscopic cholecystectomy, laparoscopic appendectomy, laparoscopic hernia repair, etc.). In the last decade, it has been gradually applied to the surgical treatment of malignant tumors. Among gastrointestinal tumor surgeries, laparoscopy is more widely used in the surgical treatment of colorectal cancer. In the surgical treatment of gastric cancer, whether laparoscopic surgery can achieve the same effect as open surgery is still a big controversy. As we all know, lymph node dissection is an extremely critical step in gastric cancer surgery. The evaluation of whether a gastric cancer surgery is standard or not mainly depends on whether the lymph node dissection is complete and adequate. As mentioned above, although open surgery has a large incision, it is still the preferred surgical approach for gastrointestinal surgeons, especially primary surgeons, because of its clear vision, large operable space, high operability and short learning curve. Laparoscopic surgery has less maneuverable space, requires higher skills and a longer learning curve, and requires a team of experienced physicians to work together skillfully to complete the surgery. I have visited most of the laparoscopic gastric cancer surgeries performed by physician teams in large centers in China. Patients are mostly in the flat-legged position, and a few are in the flat-lying position. During the operation, the operator’s position also varies. In my team, the operator is usually located on the left side of the patient, the assistant is located on the opposite side, and the hand holding the mirror is located between the patient’s legs. Some operators also stand on the right side of the patient, or between the legs, or change their position with different operating points. All these operations are performed for easier and more thorough lymph node dissection. For distal gastric cancer radical surgery, lymph node dissection on the side of the greater curvature of the stomach only needs to be completed to the 4sb group of lymph nodes, without further upward dissection, and its operation is relatively easy and is now accepted and performed by more scholars. For total gastrectomy, the difficulty and focus of lymph node dissection are mainly on the lymph nodes in groups 10 and 11d, i.e., the lymph nodes distal to the splenic hilum and splenic artery. The current view is that total gastrectomy, especially when the tumor is close to the splenic hilum, the above two groups of lymph nodes need to be cleared thoroughly. In open surgery, extraperitoneal clearance should be performed – that is, the spleen and pancreas should be completely freed and the tissue in this area should be placed outside the abdominal cavity to facilitate complete lymph node clearance. However, in laparoscopic surgery, it is more difficult to complete this step due to space and operational constraints, so lymph node dissection in groups 10 and 11d may be incomplete, which is still a controversial issue in laparoscopic gastric cancer surgery. In addition, obesity, enlarged and fused lymph nodes, and difficulty in separating them from surrounding tissues are also some of the reasons for the difficulty and incompleteness of lymph node dissection. In summary, I believe that although the technique of lymph node dissection has matured in China with larger center teams, it is still crucial to select patients appropriately for surgery and to make reasonable intraoperative decisions. Regardless of the type of operation performed and the type of decision made, the patient’s interest should be the first consideration. If the preoperative assessment of completing laparoscopic surgery is difficult, traditional open surgical treatment should be performed. In the event that intraoperative laparoscopy cannot complete the standard complete lymph node dissection, the operation should be promptly and decisively transferred to open surgery. Whether laparoscopic surgery can achieve the same long-term survival as open surgery Whether laparoscopic gastric cancer surgery can be an alternative gastric cancer surgery, whether its long-term survival is comparable to that of open surgery is the most important index. Among laparoscopic gastrointestinal surgery, laparoscopic colon cancer surgery has the strongest evidence-based medical evidence, and several large international prospective multicenter randomized controlled trials have demonstrated that laparoscopic radical colon cancer surgery can achieve the same curative outcome as corresponding open surgery, with no significant difference in long-term survival between the two. The National Comprehensive Cancer Network (NCCN) also recommends laparoscopic surgery for appropriate colon cancer patients at eligible centers. Unlike colon cancer, laparoscopic radical surgery for gastric cancer has a lower level of evidence-based medicine, and most of the published articles on laparoscopic gastric cancer surgery are focused on surgical operation techniques, perioperative evaluation and short-term outcomes, and the number of articles is small, the number of cases is small, and most of them are retrospective studies, so the NCCN does not recommend laparoscopic gastric cancer surgery at present. Firstly, the incidence of gastric cancer is unbalanced worldwide, and the incidence of gastric cancer in Europe and the United States, where large clinical studies are more mature, is lower, so it is difficult to collect a large number of cases. Secondly, there are different views on the significance and extent of lymph node dissection in the industry. Most experts and scholars in the United States recommend D1 lymph node dissection, and in some European countries even do not recommend lymph node dissection (D0), while Asian countries, led by China, Japan and Korea, uniformly consider D2 lymph node dissection as the standard surgical procedure for resectable gastric cancer in the progressive stage. Finally, there are still more controversies about the radicality of laparoscopic gastric cancer surgery in countries with high prevalence of gastric cancer. However, in the author’s opinion, it takes some time for any new technology or method to emerge, be recognized and widely used, and requires the joint efforts of experts and scholars. As China is a country with high incidence of gastric cancer, how to treat gastric cancer patients in a better and more reasonable way is a serious problem in front of us. Under the condition that adjuvant treatments such as chemotherapy and radiotherapy do not improve the survival rate of gastric cancer patients well, human-oriented and patient-centered surgical treatment, with emphasis on quality of life and improving the general condition of patients in the perioperative period under the premise of ensuring the effect of radical treatment, is the focus of our surgeons’ work. Laparoscopic surgery has demonstrated certain advantages in the surgical treatment of gastric cancer, but there is still a long way to go before it becomes a more common and optional treatment option. However, we should firmly believe in holding on to the reasonable advantages of laparoscopy and strive to create a sustainable path of laparoscopic development that suits us in the short term.