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Gastrectomy for Gastric Cancer

Subtotal and Total Stomach Resection with D2 Lymphadenectomy

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Gastrectomy for Gastric Cancer?

Gastrectomy refers to surgical resection of part or all of the stomach, with the principal indication being gastric adenocarcinoma; other indications include selected gastrointestinal stromal tumors, lymphoma, and benign disease such as refractory peptic ulcer perforation.

Subtotal (distal) gastrectomy removes the distal 60–80% of the stomach with reconstruction by Billroth II or Roux-en-Y gastrojejunostomy; total gastrectomy removes the entire stomach with esophagojejunal Roux-en-Y reconstruction.

D2 lymphadenectomy (extended nodal dissection along the celiac trunk and its branches) is the standard for curative resection in advanced gastric cancer per international guidelines.

Approaches include open, laparoscopic, and robotic; minimally invasive techniques show comparable oncologic outcomes with reduced morbidity in early gastric cancer.

Symptoms

Gastric cancer presentations: epigastric pain, early satiety, anorexia, weight loss, iron deficiency anemia
Hematemesis or melena from tumor bleeding
Dysphagia in proximal/cardia tumors; gastric outlet obstruction in distal tumors
Palpable epigastric mass, Virchow node, Sister Mary Joseph nodule, or Krukenberg ovarian metastasis in advanced disease
Postoperative concerns: anastomotic leak, hemorrhage, dumping syndrome, delayed gastric emptying, anastomotic stricture
Long-term: vitamin B12 deficiency, iron and calcium malabsorption, weight loss, post-gastrectomy syndromes (early/late dumping)

Risk Factors

Helicobacter pylori chronic infection (most important modifiable risk factor)
Diet rich in salt, smoked, and pickled foods; low fruit and vegetable intake
Smoking and excessive alcohol consumption
Family history of gastric cancer; hereditary diffuse gastric cancer syndrome (CDH1 mutation), Lynch syndrome, FAP
Atrophic gastritis with intestinal metaplasia, pernicious anemia
Male sex and advanced age; certain ethnicities (East Asian, Latin American)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent epigastric pain with weight loss or unexplained iron deficiency anemia
  • Dysphagia, persistent vomiting, or hematemesis
  • Family member with hereditary diffuse gastric cancer or CDH1 mutation
  • Surveillance endoscopic finding of gastric lesion or high-grade dysplasia
  • Postoperative fever, abdominal pain, increased drain output, or hemodynamic instability

Treatment Methods

01
Pre-operative staging: upper endoscopy with biopsy, endoscopic ultrasound for T/N staging, CT thorax/abdomen/pelvis, diagnostic laparoscopy with peritoneal washings in T3/T4 disease
02
Perioperative chemotherapy with FLOT regimen (fluorouracil, leucovorin, oxaliplatin, docetaxel) — 4 cycles before and 4 cycles after surgery — is standard for resectable cT2-T4 or node-positive disease
03
Surgical principles: R0 resection with adequate margins (5 cm proximal in diffuse type), D2 lymphadenectomy retrieving ≥16 nodes, omentectomy, and routine cholecystectomy in selected cases
04
Reconstruction tailored to extent: Roux-en-Y gastrojejunostomy after subtotal gastrectomy; Roux-en-Y esophagojejunostomy after total gastrectomy; selective use of jejunal pouch reservoirs
05
Enhanced recovery after surgery (ERAS) pathways: early mobilization, early oral intake, multimodal analgesia, no routine NG tube, early drain removal
06
Postoperative monitoring for anastomotic leak with clinical exam, drain amylase, and selective imaging; manage delayed gastric emptying with prokinetics
07
Adjuvant chemoradiation considered in patients who did not receive neoadjuvant therapy and have node-positive disease (Intergroup 0116)
08
Long-term care: vitamin B12 injections (1 mg IM every 3 months), iron, calcium, and vitamin D supplementation; small frequent meals; surveillance endoscopy and CT for 5 years

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.