RT Book, Section A1 Roses, Robert E. A1 Dempsey, Daniel T. A2 Brunicardi, F. Charles A2 Andersen, Dana K. A2 Billiar, Timothy R. A2 Dunn, David L. A2 Kao, Lillian S. A2 Hunter, John G. A2 Matthews, Jeffrey B. A2 Pollock, Raphael E. SR Print(0) ID 1164316836 T1 Stomach T2 Schwartz's Principles of Surgery, 11e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259835353 LK accesssurgery.mhmedical.com/content.aspx?aid=1164316836 RD 2024/10/05 AB Key Points Whenever testing suggests Helicobacter pylori infection, treatment should be initiated and eradication confirmed. Lifelong acid suppression should be considered in any patient admitted to a hospital because of peptic ulcer disease. Acid suppressive medication may be equivalent to surgical vagotomy in preventing recurrent peptic ulcer or ulcer complications. If possible, gastric resection for peptic ulcer is avoided in the asthenic or high-risk patient. Though less common in the United States, gastric cancer is a major cause of cancer-related morbidity and mortality worldwide. Diagnostic laparoscopy with peritoneal lavage should be considered in the evaluation of clinical stage 2 and 3 patients with gastric cancer. Multimodality therapy for gastric cancer, including resection in combination with perioperative chemotherapy or adjuvant chemoradiotherapy is associated with a survival advantage compared to surgery alone. Most patients with primary gastric lymphoma can be treated without gastric resection. Localized gastrointestinal stromal tumors of the stomach are treated with full thickness excision. Adjuvant (or neoadjuvant) imatinib is indicated for higher-risk lesions. Gastric neuroendocrine tumors may arise in the presence (types 1 and 2) or absence (type 3) of hypergastrinemia. Type 3 gastric neuroendocrine tumors should usually be treated with subtotal gastrectomy and regional lymphadenectomy. Roux-en-Y gastrojejunostomy with a large (>50%) proximal gastric remnant should be avoided because marginal ulceration and/or gastric stasis (Roux syndrome) may become problematic.