Based on previous studies of splenic hilar LN metastasis, we established that No. 10 LN metastasis is depended on primary tumor size, depth of invasion, general classification, and tumor cell type. The No. 10 LN metastasis rate of upper GC is significantly higher than that of lower GC . In the present study, a multivariate analysis was used to examine preoperative tumor size, preoperative T stage, and preoperative N stage as adverse risk factors for No. 10 LN metastasis. An analysis of 219 patients who underwent SHLND showed that the depth of invasion was closely correlated with No. 10 LN metastasis . The likelihood of No. 10 LN metastasis in patients with advanced GC was increased in patients with tumors penetrating the subserosa or muscularis, with more than 7 macroscopic LN metastases. Koga et al.  reported that No. 10 LN metastasis frequently appeared in Borrmann type IV cancer or when the primary tumor involved the serosa or entire stomach. We propose that with tumor development, the growth and invasion depth of the tumor continuously progresses, and eventually, the tumor penetrates through the muscle layer and infiltrates the placenta percreta layer because the serous layer contains an abundant capillary lymphatic network; thus, the incidence of No. 10 LN metastasis increases significantly. Moreover, GC patients with other LN metastases are closely related to No. 10 LN metastasis. The increased LN metastases and extensive transfer of the patients of preoperative staging of cN+, increases the probability of No. 10 LN metastasis. Due to the invasion of the metastatic LNs, the local anatomic structure is more complex, the intraoperative lymphadenectomy is more difficult and risky, thus more blood loss is caused by splenic vessel injury during surgery in patients with No. 10 LN metastasis than those in patients without No. 10 LN metastasis.Therefore, even if there is no difference in No. of retrieved No. 10 LNs between the two groups, patients with No. 10 LN metastasis revealed more blood loss and need more vascular clamps than those without No. 10 LN metastasis.