A adult presented with hematemesis and upper abdominal pain. Endoscopy reveals 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 6 cm up to tail of pancreas. What will be the most appropriate surgical management?
Ans. (c) Partial gastrectomy + distal pancreatectomyRef: Sabiston 19th Edition, Page 1212, NCCN 2018NCCN guidelines for Surgical resection of gastric cancer: (NCCN 2018)* Margin clearance is 4cm or more proximally* Distal resection is done up to duodenum 1st part.* Minimum number of nodes that are needed for complete staging is 15 nodes* (Cancer Breast: 10 nodes)* For proximal and Mid body gastric cancers: Total Gastrectomy.* For distal gastric cancers: Subtotal gastrectomy.* OG Junction and Tumors at cardia: Esophago gastrectomy.* Linitis Plastica (Diffuse gastric cancers) - Total gastrectomy * Pancreatectomy, Colectomy, Wedge resection of liver are accepted and done if there is a macro invasion and if resection is possible.* Splenectomy was a routine in those days for proximal gastric cancer. Now as per recent NCCN guidelines no need to remove spleen during D2 gastrectomy unless there is a direct infiltration into spleen.
Closure of the abdomen
Antrectomy and vagotomy
Partial gastrectomy + distal pancreatectomy
Partial gastrectomy +distal pancreatectomy + splenectomy
Stomach & Duodenum