Hiki N, et al. - By using the National Clinical Database (NCD) in Japan, the authors prospectively accumulate data from diverse types of hospitals and examined whether laparoscopic distal gastrectomy (LDG) was a safe and valid standard procedure. In the present Japanese nationwide survey, the safety and minimal invasiveness of LDG are confirmed. However, care must be taken to prevent the formation of pancreatic fistulas with LDG, and further improvements in surgical quality are warranted in this regard.