Total gastrectomy should be considered for malignancy high on the lesser curvature if there is no metastasis to the liver or seeding over the general peritoneal cavity, particularly in the pouch of Douglas (Figure 2). Before the surgeon is committed to a total gastrectomy, he or she must have a clear view of the posterior relationship of the stomach to determine whether the growth has extended into the adjacent structures—i.e., pancreas, mesocolon, or the major vessels (Figure 3). This can be determined by reflecting the greater omentum upward, withdrawing the transverse colon from the peritoneal cavity, and searching the transverse mesocolon for evidence of invasion. By palpation the surgeon should determine that there is free mobility of the growth without involvement of fixation to the underlying pancreas or major vessels, especially in the region of the left gastric vessels (Figure 4).