DIFFERENT SURGICAL

OPTIONS FOR GASTRIC

CANCER
SURGICAL TREATMENT OF GASTRIC
CA
Surgical resection is the only
curative treatment for gastric cancer.
Exceptions:
Patients who cannot tolerate an
abdominal operation
Patients with overwhelming metastatic
disease
SURGICAL TREATMENT OF GASTRIC
CA
The goal of curative surgical
treatment is resection of all tumor.
Thus, all margins should be negative
and an adequate lymphadectomy
performed.
EXTENT OF GASTRECTOMY
RADICAL SUBTOTAL
GASTRECTOMY
standard operation for gastric cancer
Entails ligation of the:
Left and right gastric and gastroepiploic
arteries
En bloc removal of the distal 75% of the
stomach including the pylorus, 2 cm of
duodenum, greater and lesser omentum and
all associated lymphatic tissue.
Reconstruction is by BILLROTH II
GASTROJEJUNOSTOMY
 EXTENT OF GASTRECTOMY
For patients with PROXIMAL gastric
adenocarcinoma:
TOTAL GASTRECTOOMY WITH ROUX-
EN-Y ESOPHAGOJEJUNOSTOMY
 EEXTENT OF
LYMPHADENECTOMY
Experts would agree that to avoid
understaging of gastric cancer, a
minimum of 15 nodes should be
resected with the gastrectomy
specimen.
Nodal stations:
N1 nodes: within 3cm of tumor
N2 nodes: along the celiac branches
N3 nodes: most distant from the tumor