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UPPER GASTROINTESTINAL ONCOLOGY
Total Gastrectomy with D2 Lymph Node Dissection
The standard curative operation for localised gastric cancer — combining complete stomach removal with systematic lymph node clearance to the D2 level, in line with international guidelines.
ABOUT THE PROCEDURE
Curative Surgery for Stomach Cancer with Systematic Lymph Node Clearance
Total gastrectomy with D2 lymphadenectomy is the internationally recommended standard of care for operable gastric cancer. The operation involves removal of the entire stomach along with the greater and lesser omentum and systematic clearance of lymph nodes at both the perigastric level (N1) and the level of the major arterial branches supplying the stomach (N2).
D2 dissection — removing both N1 and N2 nodal groups — has been shown in multiple randomised trials to provide superior staging accuracy and, in experienced hands, improved long-term survival compared to more limited D1 dissection, with acceptable morbidity when performed by trained surgeons.
Following total gastrectomy, bowel continuity is restored by Roux-en-Y esophagojejunostomy — connecting the oesophagus directly to a loop of jejunum. Nutritional rehabilitation, including oral supplements and dietary modification, is an essential component of post-operative recovery.
How It Is Performed
Mobilisation & Assessment
Complete mobilisation of the stomach, assessment of the omentum, and initial lymph node sampling for staging. Laparoscopic approach considered for selected early cases.
D2 Lymph Node Dissection
Systematic clearance of perigastric nodes (Station 1–6) and nodes along the left gastric, common hepatic, coeliac, and splenic arteries (Stations 7–12).
Gastrectomy
En-bloc removal of the entire stomach with clear margins confirmed by frozen section. The spleen and distal pancreas are preserved unless directly involved.
Roux-en-Y Reconstruction
Oesophagojejunostomy restores continuity. A Roux limb of 60–70cm prevents biliary reflux. A jejunal pouch may be fashioned to improve nutritional outcomes.
CANDIDACY
Who May Benefit?
Localised or locally advanced gastric adenocarcinoma
Stages I–III gastric cancer without distant metastases. Neoadjuvant chemotherapy (FLOT protocol) is recommended for T3/T4 or node-positive disease.
Gastric cancer involving the upper stomach or cardia
Tumours at the gastric cardia or body often require total rather than subtotal gastrectomy to achieve adequate margins.
Diffuse-type (signet ring) gastric cancer
Due to the infiltrative growth pattern of diffuse-type cancer, total gastrectomy with generous margins is the standard approach.
Early gastric cancer not amenable to endoscopic resection
Larger or deeper early gastric cancers (T1b or beyond) not suitable for ESD require formal surgical resection.
M.Ch AIIMS · GASTRIC ONCOLOGY
Gastric Cancer Surgery Trained at AIIMS
Dr. Imaduddin underwent comprehensive upper GI oncological training at AIIMS, including high-volume D2 gastrectomy. He has also published randomised trial data on gastric cancer surgery in the Journal of Gastrointestinal Surgery.
Consult a Specialist for Stomach Cancer Surgery
Early surgical referral for gastric cancer significantly impacts outcomes. Dr. Imaduddin provides specialist consultation for gastric cancer surgery in Hyderabad and across Telangana.