AIM:To evaluate routine modified D2 lymphadenectomy in gastric cancer,based on immunohistochemically detected skip micrometastases in levelⅡlymph nodes. METHODS:Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy,from January 2004 to December 2008,32 were classified as pN0.All levelⅠlymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the levelⅠlymph node stations(n=4)were excluded from further analysis.The levelⅡlymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS:Skip micrometastases in the levelⅡlymph nodes were detected in 14%(4 out of 28)of the patients. The incidence was further increased to 17%(4 out of24)in the subgroup of T1-2 gastric cancer patients.All micrometastases were detected in the No.7 lymph node station.Thus,the disease was upstaged from stageⅠA toⅠB in one patient and from stageⅠB toⅡin three patients. CONCLUSION:In gastric cancer,true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely. AIM: To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemically detected skip micrometastases in level II lymph nodes. METHODS: Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0.All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in groups micrometastases were detected in the level I lymph node stations (n ​​= 4) were excluded from further analysis. level II lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS: Skip micrometastases in the level II lymph nodes were detected in 14% (4 out of 28) of the patients. The incidence was further increased to 17% (4 out of 24) in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No.7 lymph node stat CONCLUSION: In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2 + / D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.