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Open Distal Gastrectomy

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Abstract

Surgical resection for gastric cancer continues to offer the only chance for cure in patients with localized disease. When used in combination with other therapies, gastrectomy can be performed safely with low morbidity and mortality to achieve the desired oncologic outcome. In this chapter we will discuss the surgical management of distal cancers of the stomach as well as pre- and postoperative considerations that are critical to achieving excellent patient outcomes.

Keywords

  • Gastric cancer
  • Subtotal gastrectomy
  • Distal gastrectomy
  • Open gastrectomy

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Correspondence to Brian Badgwell M.D., M.S. .

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Key Operative Steps

Key Operative Steps

  1. 1.

    Enter the lesser sac through the avascular plane between the omentum and transverse colon.

  2. 2.

    Mobilize the greater omentum from the transverse colon to the splenic flexure.

  3. 3.

    Expose the anterior surface of the pancreas.

  4. 4.

    Clamp and ligate the right gastroepiploic vessels.

  5. 5.

    Mobilize and retract the left hepatic lobe.

  6. 6.

    Perform lesser omentectomy up to the right crus.

  7. 7.

    Clamp and ligate the right gastric artery and vein.

  8. 8.

    Divide the duodenum with a TA stapler.

  9. 9.

    Dissect lymphatic tissues along the superior border of the pancreas from the common hepatic artery towards the celiac axis.

  10. 10.

    Clamp and ligate the left gastric vessels. Remove the nodal tissue around the artery.

  11. 11.

    Identify the splenic artery near its origin and dissect towards the splenic hilum, removing all the lymphatic tissue with the specimen.

  12. 12.

    Resect the greater omentum and ensure preservation of proximal short gastric arteries.

  13. 13.

    Divide the stomach with 5–6 cm gross margins.

  14. 14.

    Reconstruct with retrocolic Roux-en-Y or Billroth II gastrojejunostomy.

  15. 15.

    Close sites of potential internal hernia.

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Clarke, C., Badgwell, B. (2015). Open Distal Gastrectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_6

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_6

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