To compare the efficacy of laparoscopic systemic mesangectomy（SME）+D2 total gastrectomy with standard laparoscopic D2 total gastrectomy in patients with advanced gastric cancer.

Seventy patients with advanced gastric cancer who underwent laparoscopic total gastrectomy（LTG）from January 2018 to December 2020 were selected as the study objects. The patients were divided into SME group and standard group by random number table method，with 35 cases in each group. SME group：Laparoscopic total gastrectomy +D2 lymph node dissection based on SME，standard group：laparoscopic total gastrectomy +D2 lymph node dissection. The data was processed by SPSS 22.0 software. Measurement data such as perioperative indicators were represented by（

The operative time，intraoperative blood loss，first postoperative exhaust time，first eating time and postoperative hospital stay in SME group were significantly lower than those in standard group，and the number of lymph nodes dissection was significantly higher than that in standard group，with statistical significance（P<0.05）. There was no significant difference in the total incidence of postoperative complications between the two groups（20.0% vs.14.3%）（P>0.05）. During the follow-up period，Kaplan-Meier analysis showed that the cumulative overall survival rate（68.6% vs.85.7%）and disease-free survival rate（65.7% vs.82.9%）between the standard group and the SME group were significantly different（Log-Rank χ²=4.068，4.587，P=0.044，0.032）.

Compared with the standard D2 total gastrectomy，SME+ D2 total gastrectomy not only reduces the operation time，reduces intraoperative blood loss，is more conducive to postoperative recovery of patients，and does not increase the occurrence of surgical risks，but also enables more thorough dissection of lymph nodes，is more conducive to improving the prognosis of patients，and achieves better surgical efficacy，which is worthy of popularization and application.