Gastric Cancer

Question 1

Total gastrectomy

Answer 1

• Supine, arms out, OGT
• Upper midline laparotomy
• Open gastrohepatic ligament, watch for accessary left hepatic
• Mobilize GE junction circumferentially
• Divide gastrocolic ligament, takedown short gastric vessels close to spleen.
• Take celiac, splenic, common hepatic LN, greater omentum.
• Ligate Left, Right gastric ,and left and right gastroepiploic vessels at their base.
• Divide duodenum with endo GIA tapler 2-3 cm distal to pyloric vein-oversew.
• TA tapler to distal esophagus-ensuring 5 cm margin.
• Reconstruct using Roux limb of jejunum.
• Fashion jejunostomy tube.
• Leave drains at D stump and EJ

Question 2

Gastric Ca Clinical Stage 1

Answer 2

1A: T1N0M0
1B: T2N0M0

Question 3

Gastric Cancer T1a

Answer 3

Lamina propria or muscularis mucosa

Question 4

Gastric Cancer T1b

Answer 4

Submucosa

Question 5

Gastric Cancer T2

Answer 5

Muscularis propria

Question 6

Gastric Cancer T3

Answer 6

Penetrates subserosa

Question 7

Gastric Cancer T4

Answer 7

Invades serosa and surrounding structures

Question 8

Gastric Clinical Cancer Stage 2

Answer 8

IIA: T1NanyM0, T2NanyM0
IIB: T3N0M0, T4aN0M0

Question 9

Gastric Clinical Cancer Stage 3

Answer 9

III: T3NanyM0, T4aNanyM0

Question 10

Gastric Clinical Cancer Stage 4

Answer 10

IVA: T4b any N0,M0
IVB: M1

Question 11

D1 LN

Answer 11

1-right cardia
2-left cardia
3-lesser curve
4-greater curve left/right
5-supra-pyloric
6-infra-pyloric

Question 12

D2 LN

Answer 12

7-left gastric
8-common hepatic
9-celiac
10-splenic hilum (optional)
11-splenic artery