Cancer of the stomach at the gastroesophageal junction – Total Gastrectomy

A 52 year-old gentleman noticed that he felt “full” after eating smaller portions of food compared to the past. He also lost weight and developed anemia. Gastroscopy revealed a large, irregular mass located at the fundus of the stomach. Biopsy confirmed cancer of the stomach. CT-scan demonstrated that this tumor extended outside the stomach towards the aorta. This finding suggested that no matter how extensive the operation might be, it would not be as “radical” as it should. In other words, the operation would not be able to achieve widely healthy margins. For these reasons, preoperative chemotherapy was offered. Indeed, after a while, the patient started eating again his usual portions of food and CT documented significant decrease in the size of the tumor, which had now shrunk away from the aorta. During the operation, removal of the entire stomach was performed, as well as complete “lymph node dissection”, which is the removal of all lymph node-bearing tissues around the stomach including all the tissue around the aorta (D2- lymph node dissection). Then the esophagus was connected to the small bowel. Postoperativel, the patient did very well and went home on the 9th postoperative day.

Computerized Tomography (CT) at diagnosis, before chemotherapy

Very large size of the cancer of the stomach with enlarged lymph nodes

The arrows show the large size of the tumor at the time of diagnosis.

Computerized Tomography (CT), after chemotherapy

The arrows demonstrate the significant shrinkage of the tumor after chemotherapy

The arrows demonstrate the significant shrinkage of the tumor after chemotherapy.

Radical lymph node dissection
to the level of the aorta

Appropriate lymph node dissection during gastrectomy for cancer

Complete skeletonization of the aorta from the lymph nodes and transection of the left gastric artery at its origin.

Total radical gastrectomy -
Operative specimen

Appropriate radical surgery in total gastrectomy for cancer

The extend and radicality of resection of all tissues around the stomach, is demonstrated.