This procedure includes resection of the cardia, fundus, stomach body, and distal esophagus while preserving the stomach's antrum.
Narrator: For the treatment of locally advanced gastroesophageal and proximal gastric cancer tumors, a modified proximal gastrectomy with lymphadenectomy is performed.
The lymph node stations surrounding the stomach have been precisely defined. The lymph node stations taken during a standard D2 lymphadenectomy are stations 1 at the right pericardium, 2 at the left pericardium, 3 along the lesser curvature, 4a along the proximal greater curvature, 4b along the distal greater curvature, 5 along the right gastric artery, 6 along the right gastropoleic artery, 7 along the left gastric artery, 8 along the common hepatic artery, 9 at the celiac axis, 10 at the splenic hilum, 11 along the splenic vessels, and station 12 along the proper hepatic artery and hepatogastric ligament.
Our modified approach also removes the lower mediastinal lymph node stations 110 and 111, as these stations are at risk of metastasis with tumor extension into the distal esophagus.
During the modified proximal gastrectomy, the stomach is transected at the incensura, sparing the antrum while removing the gastric body, fundus, cardia, and distal esophagus.
The station 5 lymph nodes along the right gastric artery and station 6 lymph nodes along the right gastropoic artery are not removed, as these stations are at low risk of metastasis from proximal stomach and gastroesophageal tumors.
During a double -track reconstruction, an esophagojejunostomy is created in the lower chest. Approximately 10 to 15 centimeters distally, an end-to-side gastrojejunostomy with the rue limb and the antrum is created.
The stomach can be fixed to the right cruce, if necessary, to facilitate the horizontal angle of the antrum.
We then measure 20 to 25 centimeters of Rue limb below the transverse colon mesentery to create an end to side jejuno-jejunostomy.