Basic principles of radical gastrectomy for gastric cancer

The basic principles of radical gastrectomy for gastric cancer are as follows:

1. Close meridian approach and wide incision

When choosing the best incision for radical resection of gastric cancer, the location of gastric cancer and the possible range of spread should be considered. After opening, the cancer can be directly presented to the surgeon, and it is easy to understand the overall picture of regional spread. To this end, the route must be close and the incision must be wide. If it is found during the operation that the incision cannot meet the requirements of radical surgery, the incision should be enlarged or changed. This is also the basic condition to avoid iatrogenic spread caused by squeezing during the operation and to ensure complete removal of lymph nodes and good suture.

2. Block the blood and lymph flow of the tumor as soon as possible

In order to prevent iatrogenic hematogenous and lymphatic cancer spread caused by surgical operation, for patients who can undergo radical surgery, the left and right gastric blood vessels, the left and right gastroepiploic blood vessels, and their surrounding tissues are first bundled and sutured and ligated. However, the nearby lymph nodes should not be separated or dissected for this purpose.

3. Avoid mechanical stimulation of the tumor

Mechanical stimulation of the tumor, especially rough squeezing, can cause cancer cells to flow into blood vessels and lymphatic vessels. During the operation, the operation should be gentle. When the stomach needs to be lifted during the operation, the healthy part of the stomach wall should be lifted and grasped, and direct lifting and grasping of the tumor should be avoided as much as possible. If cancer invades the serosa, it used to be covered with 4-6 layers of gauze and sutured for protection, or wrapped with free greater omentum to prevent cancer cells from falling into the abdominal cavity. In recent years, medical F-HT glue has been used to apply to the invaded part of the serosa. The method is simple and the covering effect is good. At present, the first two methods are rarely used.

4. Extensive gastrectomy

In order to prevent residual cancer in the gastric wall, the pericancer stomach should be extensively resected. For example, in the case of lower gastric cancer, the duodenal cutting line should be as far away from the pyloric ring as possible and close to the attachment of the pancreatic head. The oral gastric cutting line is 2 cm below the right side of the cardia on the lesser curvature side and at the second and third terminal branches of the left gastroepiploic artery or the lower pole of the spleen on the greater curvature side. The scope of gastrectomy should also be determined with reference to the gross type of the tumor. For localized cancer (Bonmann type 1 and 2), the stomach should be cut at least 3-4 cm outside the cancer edge, and for invasive cancer (Bonmann type 3 and 5), the stomach should be cut at least 5-10 cm outside the cancer edge. For Borrmann type 4 gastric cancer, total gastrectomy or combined organ resection is usually appropriate.

5. Systematically and thoroughly remove the perigastric lymph nodes

Surgeons must be familiar with the distribution and codes of the perigastric lymph nodes, the range of each station to which various gastric cancers belong, and master the techniques for clearing the lymphatic system.