Gastric cancers are rare and not diagnosed on a single, initial evaluation. Symptoms are vague like indigestion, heartburn, constant burping and persistent abdominal pain. In advanced gastric cancers, black stools, blood in the stools, weight loss and loss of appetite are noted. Surgical resection is the primary and only reliable management of gastric cancer. The goal of the surgery is to completely remove all signs of tumour with histologically-free surgical margins.
Before the surgery, staging of the cancer is conducted and its spread pattern is evaluated. The extent of gastric resection depends on the proliferation of the cancer and infiltration of the tumour through the gastric wall, the adjacent organs and lymph nodes. A total gastrectomy is conducted if the cancer is located in the corpus of the stomach. A reconstructive Roux-en-Y oesojejunostomy is carried out to improve the post-operative life of the patient.
Subtotal distal gastrectomy is done for cancer of the antrum. Billroth I or II procedures are conducted as reconstructive surgeries along with a Roux-en-Y to avoid bile-reflux and a compulsory vagotomy to prevent the occurrence of an anastomotic peptic ulcer. Patients suffering from gastroesophageal reflux are recommended total duodenal diversion, a type of reconstructive surgery.
Special approaches are designated for cancer of the cardia and are assimilated as lower oesophageal cancers. A total gastrectomy is achieved for lesions in the cardia. A proximal oesophageo-gastrectomy through the abdominal and right thoracic approach is advised for lesions that have found its way into the lower oesophagus.
A total gastrectomy is performed for Borrmann type 4 infiltrative gastric cancers. They frequently occur as wide extensions through the gastric wall and a wider resection to the adjacent organs is indicated.
The prognostic feature of gastric cancer remains lymph node extensions. Curative treatment is total gastrectomy with a 1.5 inch dissection of the lymph node between D1 and D2. This is inclusive of splenic lymph node dissection but may not comprise of a splenectomy.
Neoadjuvant chemotherapy and intraoperative radiotherapy are done to downstage the disease, decrease micrometastatic disease and enhance the possibilities of resection. Following the surgery, patients find trouble with food intake. Placement of a tube at the time of gastrectomy along with a J-tube protruding out of the skin will allow liquids directly into the intestine to avoid malnutrition.