An adult presented with hemetemesis and upper abdominal pain. Endoscopy revealed a growth at the pyloric antrum of the stomach. CT scan showed growth involving the pyloric antrum without infiltration or invasion into surrounding structures and no evidence of distant metastasis. At Laparotomy neoplastic growth was observed to involve the posterior wall of stomach and the pancreas extending 6cm up to tail of pancreas. What will be the most appropriate surgical management?
Gastric cancer have various treatment modalities. Based on this scenario, this patient falls in to T4N0M0, i.e., tumor spreading to adjacent tissues (pancreas), no regional lymphnodes involvement and no metastasis will have to go paial gastrectomy and distal pancreatectomy. Ref: Surgery in the Multimodal Management of Gastric Cancer By Giovanni De Manzoni, Walter Siquini, Franco Roviello, 2012, Page 60
Closure of the abdomen
Antrectomy and vagotomy
Paial Gastrectomy + Distal pancreatectomy
Paial Gastrectomy + Distal pancreatectomy + splenectomy