For advanced proximal gastric cancer (GC), the No. 10 lymph node (LN) is a crucial link in lymphatic drainage. Previous reports have found that the No. 10 LN metastasis rate is approximately 9.5% to 27.9% [1–3]. According to 14th edition of the Japanese gastric cancer treatment guidelines, D2 lymphadenectomy is the standard procedure for advanced GC, and the No. 10 LN should be dissected for the treatment of advanced upper GC. In recent years, as the concept of preserving viscera function and the use of minimally invasive technology has been accepted by an increasing number of clinicians, laparoscopic spleen-preserving splenic hilar LN dissection (SHLND) has become a valuable treatment option, and its use has gradually increased. In 2008, the South Korean scholar Hyung et al.  reported the first use of laparoscopic treatment to preserve the spleen during SHLND of upper GC, achieving a good curative effect and indicating that the operation is safe and feasible. Since then, the use of laparoscopic surgery to preserve the spleen during SHLND has increased . However, this technology is difficult to implement in clinical practice because the spleen is deep, the operating space is narrow, and the splenic vessels are rich in this area and their branches are particularly complex. Thus, improvements in the preoperative prediction of No. 10 LN metastasis, which could provide medical evidence for SHLND indications, are urgently needed. However, few studies have focused on this topic. Therefore, we performed a retrospective study of patients subjected to laparoscopic spleen-preserving SHLND surgery to explore the preoperative factors associated with No. 10 LN metastasis and establish a new scoring system to preoperatively predict the risk of No. 10 LN metastasis.