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Laparoscopic Subtotal Gastrectomy with D2 Lymphadenectomy

Minimally invasive distal gastric cancer resection with extended lymph node dissection.

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 Laparoscopic Subtotal Gastrectomy with D2 Lymphadenectomy?

Laparoscopic subtotal (distal) gastrectomy with D2 lymphadenectomy is the operation of choice for cT1-T3 N0-N2 distal-third gastric adenocarcinoma. The distal stomach is removed with adequate proximal margin, and the D2 nodal package includes perigastric stations 1, 3-7 and second-tier stations 8a, 9, 11p, and 12a along the celiac, common hepatic, splenic, and proper hepatic arteries.

Reconstruction options include Billroth II, Roux-en-Y gastrojejunostomy, or uncut Roux-en-Y, with Roux-en-Y favored for reduced bile reflux and improved long-term function. Pre-operative staging includes CT, endoscopic ultrasound, and diagnostic laparoscopy with peritoneal cytology when serosa is involved or signet-ring/diffuse-type histology is present. Perioperative or neoadjuvant chemotherapy (FLOT) is standard for stage II/III disease.

KLASS-02, JLSSG0901, and CLASS-01 trials show non-inferior 3-year overall and disease-free survival compared to open D2 gastrectomy, with shorter hospital stay, less blood loss, and lower wound complications. ERAS protocols, robotic platforms, and intracorporeal anastomosis are increasingly standard.

Symptoms

Postprandial epigastric pain and dyspepsia
Iron deficiency anemia
Unintentional weight loss
Early satiety and vomiting
Melena or hematemesis
Palpable epigastric mass (advanced)
Helicobacter pylori chronic gastritis

Risk Factors

Helicobacter pylori chronic infection
Family history of gastric cancer
Smoking and high salt diet
Pernicious anemia and atrophic gastritis
CDH1 and Lynch syndrome mutations
Prior partial gastrectomy
EBV-associated and signet-ring histology

When to See a Doctor?

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

  • New dyspepsia after age 55 with alarms
  • Iron deficiency anemia in older adult
  • Unintentional weight loss with vomiting
  • Family history of gastric cancer with symptoms
  • Suspicious lesion on endoscopy

Treatment Methods

01
Multidisciplinary tumor board discussion
02
Preoperative CT, EUS, diagnostic laparoscopy
03
Perioperative FLOT chemotherapy in stage II-III
04
Laparoscopic subtotal gastrectomy with D2 dissection
05
Roux-en-Y reconstruction preferred
06
ERAS perioperative pathway
07
Post-resection chemotherapy and nutrition support

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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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.