Objective：To assess the efficacy and safety of D2+paraaortic lymph node dissection  (LND) (D4) for patients with advanced gastric cancer.
Methods：We searched the electronic bibliographic databases, including Cochrane library, Pubmed, EMBASE, CBM, VIP, CNKI and WABNGFANG to assemble the RCT of D2 and D4 LND for patients with advanced gastric cancer. The deadline retrieval time was October 2009. Data were extracted and evaluated by two reviewers independently.The RevMan 5.0 software was used for data analysis.
Results： Four randomized trials involving 1120 patients were included. The results indicated that compared with D4 LND, D4 LND dissection did not increase the patient′s survival rate, and there was no significant difference in the cancer recurrence rate after operation, postoperative mortality or the incidence of complications between the D2 and D4 LND.
Conclusions：Because of the limitations of the included studies,  the efficacy and safety of D2 and D4 LND for patients with advanced gastric cancer could not be  accurately assessed.