Inclusion Criteria:

- Age from over 18 to under 75 years

- Primary gastric adenocarcinoma (papillary, tubular, mucinous, signet ring cell, or
poorly differentiated) confirmed pathologically by endoscopic biopsy

- cT2-4a, N0-3, M0 at preoperative evaluation according to the AJCC Cancer Staging
Manual Seventh Edition

- Expected curative resection through distal subtotal gastrectomy with D2
lymphadenectomy

- Performance status of 0 or 1 on ECOG (Eastern Cooperative Oncology Group) scale

- ASA (American Society of Anesthesiology) score class I, II, or III

- Written informed consent

Exclusion Criteria:

- Women during pregnancy or breast-feeding

- Severe mental disorder

- History of previous upper abdominal surgery (except laparoscopic cholecystectomy)

- History of previous gastrectomy, endoscopic mucosal resection or endoscopic
submucosal dissection

- Enlarged or bulky regional lymph node diameter over 3cm by preoperative imaging

- History of other malignant disease within past five years

- History of previous neoadjuvant chemotherapy or radiotherapy

- History of unstable angina or myocardial infarction within past six months

- History of cerebrovascular accident within past six months

- History of continuous systematic administration of corticosteroids within one month

- Requirement of simultaneous surgery for other disease

- Emergency surgery due to complication (bleeding, obstruction or perforation) caused
by gastric cancer

- FEV1＜50% of predicted values