In patients with gastric cancer, gastrectomy can be performed via laparoscopic/robotic or open surgery. It is crucial to completely remove the tumor along with an adequate extent of lymph node dissection. The number of lymph nodes retrieved during gastrectomy is considered an important factor associated with the quality of the surgery and can serve as an indicator of the completeness of the procedure.

In particular, during the dissection of lymph node stations 8, 9, 11p and 12a - which are located near the superior aspect of the pancreas - pressure is often applied to the pancreas to secure an adequate surgical view. Recent studies have suggested that this may be associated with postoperative pancreatic complications.

It is believed that the use of articulating instruments during laparoscopic gastrectomy may enable a safer dissection of lymph nodes located above the pancreas. However, to date, there have been lack of studies comparing the safety and efficacy of articulating versus straight instruments in laparoscopic gastrectomy. Therefore, this study aims to analyze the compare these two approaches.

Inclusion Criteria:

1. Patients diagnosed with gastric adenocarcinoma pathologically before surgery
2. Patients scheduled for laparoscopic radical gastrectomy
3. Patients aged more than 20
4. Patients with an ECOG 0 or 1

Exclusion Criteria:

1. Patients with a history of gastrectomy
2. Patients with a history of pancreatitis or pancreatic surgery
3. Patients with a history of abdominal surgery who are expected to have severe intra-abdominal adhesions
4. Patients scheduled for total gastrectomy with D2 lymph node dissection

Patients were randomly assigned in a 1:1 ratio to two groups; the control group or the experimental (Articulating) group.