Gastric cancer continues to be a leading cause of cancer death. The majority of patients with gastricadenocarcinoma in China present with advanced disease. Ruling out unresectable cancers from an unnecessary‘‘open’’ exploration is very important. The aim of this study was to assess the value of five-port anatomicallaparoscopic exploration in T4 gastric cancer in comparison with three-port laparoscopic exploration andlaparotomy exploration. We conducted a retrospective study on 126 patients with T4 stage scheduled for D2curative gastrectomy based on computed tomography (CT) staging at Department of Gastric Cancer and SoftTissue Sarcoma, Fudan University Shanghai Cancer Center, from Apr. 2011 to Apr. 2013. Laparotomy exploration(Group I), three-port laparoscopic exploration (Group II) or five-port anatomical laparoscopic exploration (GroupIII) were performed prior to radical gastrectomy. Accuracy rate for feasibility of D2 curative gastrectomy inlaparotomy exploration and five-port anatomical laparoscopic exploration groups was higher than that in thethree-port laparoscopic exploration group. Five-port anatomical laparoscopic exploration group had the highestaccuracy resection rate (Group I vs Group II vs Group III,92.6% vs78.6% vs 97.7%; p<0.05) and shorter lengthof hospitalization (Group I vs Group II vs Group III, 9.58±4.17 vs 6.13±2.85 vs 5.00±1.81; p<0.001). Three-portlaparoscopic exploration has low accuracy rate for assessing feasibility of D2 curative gastrectomy and five-portanatomical laparoscopic exploration should be performed on patients with T4 gastric cancer.