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HIPEC
PIPAC
Cytoreductive Surgery
Whipple’s Procedure
Total Gastrectomy D2
Minimally Invasive Oesophagectomy
Colorectal Cancer TME
Liver Metastases Resection
Ovarian Cancer Debulking
Retroperitoneal Tumour Resection
Pelvic Exenteration
Appendix Cancer & PMP
Understanding Gastric (Stomach) Cancer
Gastric cancer is the fifth most common cancer worldwide and remains a significant health burden in India, particularly in the southern states. The majority are adenocarcinomas arising from the gastric mucosa, though lymphomas and GISTs (gastrointestinal stromal tumours) also occur in the stomach and require different management.
The hallmark of curative gastric cancer surgery is adequate oncological resection with a D2 lymph node dissection — removing at least 16–25 lymph nodes from the regional lymphatic stations. Studies from Japan and South Korea have conclusively demonstrated that D2 dissection significantly improves survival compared to D1, and it is now the international standard. However, it requires specialist training to perform safely.
Gastric cancer has a high propensity for peritoneal spread — present at diagnosis in 10–20% of patients and developing during follow-up in a further 20–30%. For these patients, HIPEC (heated intraperitoneal chemotherapy) and PIPAC represent additional therapeutic weapons that can improve outcomes beyond what systemic chemotherapy alone achieves.
At a Glance
Symptoms of Gastric Cancer
Early gastric cancer is usually asymptomatic. Symptoms typically appear when the tumour is already advanced — any persistent upper GI symptoms should be investigated with endoscopy.
Difficulty swallowing or feeling full after small amounts — particularly for tumours near the cardia.
Significant weight loss over weeks to months, often with anorexia.
Vomiting blood or passing black tarry stools indicates ulceration and bleeding.
Persistent, burning upper abdominal pain — often misattributed to acid reflux or ulcers.
Especially post-meals; outlet obstruction causes projectile, undigested food vomiting.
Iron-deficiency anaemia from chronic occult blood loss — often the only initial abnormality.
Surgical Treatment of Gastric Cancer
The standard of care for resectable gastric cancer is total or subtotal gastrectomy with D2 lymphadenectomy — removing the tumour-bearing portion of the stomach plus a comprehensive regional lymph node dissection. In my practice, I perform D2 dissection for all gastric cancers with curative intent, following the Japanese Gastric Cancer Association guidelines.
For tumours of the proximal stomach and cardia, a total gastrectomy with Roux-en-Y oesophagojejunostomy reconstruction is performed. For tumours of the antrum or body, a subtotal gastrectomy preserves gastric function and quality of life. Multimodal treatment combining surgery with perioperative chemotherapy (FLOT protocol) has become the standard in Western practice and significantly improves survival.
When peritoneal involvement is present, I consider synchronous HIPEC during the gastrectomy in eligible patients — a strategy supported by growing evidence including the DRAGON-II and GASTRIPEC trials. For metastatic or recurrent peritoneal disease, PIPAC offers repeated low-toxicity intraperitoneal treatment.
Complete removal of the stomach with comprehensive D2 nodal clearance — the oncological gold standard for gastric cancer.
Heated intraperitoneal chemotherapy combined with gastrectomy when peritoneal involvement is detected.
Minimally invasive laparoscopic aerosol chemotherapy for peritoneal recurrence after gastrectomy.
Expertise You Can Trust
Dr. Mohammed Imaduddin brings internationally trained surgical skills and a patient-first philosophy to every case.
Frequently Asked Questions
Questions I regularly hear from patients with gastric cancer and their families.
Can I live normally after total gastrectomy?
What is a D2 lymphadenectomy and why does it matter?
What is the FLOT chemotherapy regimen?
Does gastric cancer always spread to the peritoneum?
Is laparoscopic gastrectomy an option?
Ready to Discuss Your Case?
Every cancer journey is different. I offer a detailed, unhurried consultation to help you understand your options and make informed decisions.