| Popis: |
Total gastrectomy (TG), a total resection of the whole stomach including the cardia and pylorus, is a surgical procedure to treat gastric cancer which is located in proximal stomach and in a case that a satisfactory proximal resection safety margin cannot be guaranteed by distal gastrectomy. As like distal gastrectomy, the extent of lymph node (LN) dissection of TG for advanced gastric cancer is recommended in D2 level, and D2 level for TG additionally includes #2 (left paracardial LNs including those along the esophagocardiac branch of the left subphrenic artery), #4sa (left greater curvature LNs along the short gastric arteries), #10 (splenic hilar LNs including LNs in splenic artery distal to the pancreatic tail, in the roots of the short gastric arteries, and along the left gastroepiploic artery proximal to its first gastric branch), and #11d (distal splenic artery LNs from halfway between its origin and the pancreatic tail end, usually from the beginning of posterior gastric artery from splenic artery, to the end of the pancreatic tail) LN groups along with those of distal gastrectomy. TG for gastric cancer is one of challenging surgical procedure because the extent of TG is wider than that of distal gastrectomy, LN dissection around spleen hilum is technically difficult, and surgical complications such as leak from esophagojejunostomy and pseudoaneurysm at splenic artery could be lethal. In addition, combined resection versus preservation of adjacent organs such as the pancreas and spleen for TG has long been in a debate. In this chapter, we will discuss about the historical changes of surgery for TG and technical aspects for TG with LN dissection. Detailed technique for reconstruction after open TG will be addressed in another chapter. |
