RT Book, Section
A1 Hunter, John G.
A1 Spight, Donn H.
A1 Sandone, Corinne
A1 Fairman, Jennifer E.
SR Print(0)
ID 1162530505
T1 Gastrectomy with Roux-en-Y Reconstruction
T2 Atlas of Minimally Invasive Surgical Operations
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071449052
LK accesssurgery.mhmedical.com/content.aspx?aid=1162530505
RD 2024/04/19
AB Gastrectomy  is  most  often  performed  for  gastric  cancer  or  peptic  ulcer  disease.  The  complexity  of  the  operation  needs  to  be  matched  with  the  expertise  of  the  surgeon.  Wedge  resection  of  a  small  gastric  tumor  (e.g.,  leiomyoma)  falls  on  the  simpler  end  of  the  complexity  spectrum  and  can  be  performed  by  most  well-trained  minimally  invasive  general  surgeons.  Total  gastrectomy  with  J-pouch  reconstruction  and  D2  lymph  node  dissection  for  proximal  gastric  cancer  falls  on  the  more  difficult  end  of  the  complexity  spectrum  and  should  be  performed  by  experts  in  minimally  invasive  surgery  for  upper  GI  malignancy.  This  chapter  addresses  the  more  complex  procedures,  subtotal  and  total  gastrectomy,  with  extensive  (D2)  lymph  node  dissection,  the  international  “standard”  for  gastric  cancer  surgery.  D2  dissection  requires  removal  of  lymph  node  stations  along  the  celiac  trunk,  left  gastric,  splenic,  and  hepatic  arteries.  Familiarity  with  regional  lymph  node  anatomy  and  the  international  naming  conventions  is  critical  to  adequate  lymph  node  harvest  and  subsequent  staging  (Figure  1).  The  final  anatomy  of  the  subtotal  gastrectomy  with  Roux  en  Y  gastrojejunostomy  is  shown  (Figure  2).