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Background: Stomach carcinoma, the second most prevalent malignancy in Asia, poses a substantial global public health challenge. Gastric adenocarcinoma, comprising over 90% of cases, necessitates optimal treatment modalities, primarily RO resection, to achieve locoregional control. Lymph node metastasis, the primary mode of spread, underscores the importance of meticulous lymphadenectomy. The Japanese Gastric Cancer Association (JGCA) guidelines delineate the critical role of D2 lymphadenectomy in staging and controlling gastric carcinoma. Methodology: This retrospective study, conducted at SCB Medical College & Hospital, assesses the necessity of routine D2 lymphadenectomy in operable cases of gastric carcinoma. Forty-six patients meeting specific criteria underwent detailed workup, including hematological and radiological evaluations. Operable cases underwent gastric resection with D2 lymphadenectomy, targeting a minimum of 16 lymph nodes. Extended resections and palliative procedures were performed as needed. Results: The study comprised 46 patients (56% male, 44% female), aged 55-65 years. Clinical presentations included dyspepsia (63%), weight loss (54.3%), and less common symptoms. Antral growth was predominant (54.3%). Operable cases (87%) underwent successful D2 lymphadenectomy with minimal complications (4% pulmonary complications, 6% wound infections). The majority were stage II and III (77.5%). Two-year follow-up indicated a 5% mortality and recurrence rate. Discussion: Surgical intervention, particularly D2 lymphadenectomy, remains the most effective therapeutic option for gastric carcinoma. Our study aligns with JGCA guidelines, emphasizing the importance of D2 lymphadenectomy in achieving locoregional control. The inadequacy of D1 lymphadenectomy is evident, highlighting the significance of removing an adequate number of lymph nodes. Despite concerns, evidence suggests that the current form of D2 lymphadenectomy is not more hazardous than D1, and maximal lymph node removal correlates with improved long-term survival. Conclusion: Our study underscores the critical role of D2 lymphadenectomy in achieving optimal locoregional control and improving overall survival in gastric carcinoma. The meticulous removal of an adequate number of lymph nodes is imperative, emphasizing adherence to established guidelines for lymphadenectomy. [ABSTRACT FROM AUTHOR]