Gastrectomy - Partial/Total
- If open, the incision is an upper vertical midline laparotomy.
- Open the gastrocolic ligament by taking the short gastric arteries.
- Determine type of resection necessary based on the pathologic process and dissect proximal/distal depending on type of gastrectomy.
- Dissect the lesser omentum and include with the specimen (lymph nodes).
- Resect the greater omentum and include with the specimen (lymph nodes).
- Staple across the stomach at the necessary levels to provide more than 5-cm margins.
- Determine method of reconstruction—Billroth II gastrojejunostomy versus Roux-en-Y gastrojejunostomy versus esophagojejunostomy.
- A D2 lymphadenectomy is recommended by NCCN.
