Laparoscopic D2 lymphadenectomy with complete mesogastrium excision offers significant benefits for locally advanced upper gastric cancer patients.

• Reduced intraoperative blood loss: 89.4 ml vs. 145.7 ml (p < .001).
• Increased lymph node yield: 42.9 vs. 37.1 (p = .008).
• Faster postoperative recovery: hospital stay of 14 days vs. 15 days (p = .035).

Patients with stage T4a particularly benefit with improved long-term survival and disease-free outcomes.