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Case 125: Distal Gastric Cancer

A 62 year old man presented with upper abdominal symtoms of mild dyspepesia. On gastroscopy he was found to have an early distal gastric cancer

1. What is this operation called?

A subtotal gastrectomy.

The entire greater omentum has been removed along with the nodal tissue seen along the lesser curve of the stomach specimen. A modification of the 'D2' gastrectomy which includes a 'bursectomy' (excising the lesser sac intact), and nodal dissection of the common hepatic artery and the coeliac axis group (including the nodes at the origin of the left gastric artery which is taken). The spleen and the splenic hilar nodal group have not been removed, nor has the distal pancreas. This extension to the operation has not been shown to improve survival enough to compensate for the increased morbidity.

2. What are the possible nutitional problems following such a procedure?

Intake restriction and weight loss due to:
A small gatric pouch.
delayed gastric emtying
Stomal problems
efferent loop symdrome (Roux Limb Syndrome)

Iron deficiency anaemia
B12 deficiency due to loss of intrinsic factor - more a problem with total gastrectomy

3. Define 'early gastric cancer'

Early gastric cancer (EGC) is defined as gastric cancer confined to the mucosa or submucosa, regardless of the presence or absence of lymph node metastasis.

Early Gastric Cancer : pretreatment diagnosis.

Management of Early Gastric Cancer in Japan.