If the exploratory peritoneoscopy does not reveal contraindications to resection, the abdomen is opened and a careful regional inspection with palpation is performed. It must also be determined whether there have been direct extension and fixation to adjacent structures, such as the pancreas, liver, or spleen. Additional information may be obtained as to the extent and fixation of the tumor mass by exploring the lesser omental cavity through an opening made in the relatively avascular gastrohepatic ligament (Figure 2). Evidence of fixation of the posterior gastric wall with the pancreas or involvement of the tissues about the middle colic vessels should be sought. However, in the absence of visible or palpable distance metastases, it may be feasible to excise the stomach, en masse, along with the spleen and portions of the left lobe of the liver, or tail and body of the pancreas, if the involvement is by direct extension of the tumor. If there is widespread metastatic involvement with impending pyloric obstruction, it may be wiser to avoid radical surgery and to carry out the simple procedure of anterior or posterior gastrojejunostomy.