A subtotal gastrectomy with D2 dissection performed for Stage 3 gastric adenocarcinoma in the antrum includes:
A. Grossly negative margins of 2 cmSurgical resection is the only curative treatment for gastric cancer and most patients with clinically resectable locoregional disease should have gastric resection. The standard operation for gastric cancer is radical subtotal gastrectomy, which entails ligation of the left and right gastric and gastroepiploic arteries at the origin, as well as the en bloc removal of the distal 75% of the stomach, including the pylorus and 2 cm of duodenum, the greater and lesser omentum, and all associated lymphatic tissue. Generally, the surgeon strives for a grossly negative margin of at least 5 cm. More than 15 resected lymph nodes are required for adequate staging, even in the low-risk patient. The operation is deemed an adequate cancer operation provided that tumor-free margins are obtained, > 15 lymph nodes are removed, and all gross tumor is resected. In the absence of involvement by direct extension, the spleen and pancreatic tail are not removed. Reconstruction is usually by Billroth I gastrojejunostomy or Roux-en-Y reconstruction.