Part 3 – Stomach Cancer Surgery: Removing Tumor & Lymph Nodes | Dr Subrahmanyeshwar | GI Focus|Day 1

In this Part 3 session, Dr Subrahmanyeshwar Babu explains function-preserving approaches in stomach cancer surgery, focusing on subtotal, proximal, and pylorus-preserving gastrectomies. He describes how surgeons selectively remove lymph nodes along key arteries—like the left gastric, common hepatic, celiac, and proximal splenic arteries—while preserving others, such as the splenic hilar nodes, unless visibly enlarged. The difference in lymph node removal distinguishes subtotal from total gastrectomy.

Dr Babu emphasizes the rationale behind these surgeries, noting that countries like Japan and Korea detect many stomach cancers early, leading to excellent five-year survival rates. In such cases, function-preserving procedures improve long-term nutrition, reduce complications like bile reflux and dumping syndrome, and maintain quality of life. Pylorus-preserving gastrectomy is suitable for mid-stomach tumors, keeping the distal stomach intact, while proximal gastrectomy removes upper stomach tumors but preserves more than half of the stomach. Careful preservation of nerves to the liver and pylorus is critical to minimize side effects.

He concludes that early gastric cancers treated with these approaches have similar long-term survival to total gastrectomy, though ongoing studies continue to evaluate nutritional outcomes and quality of life benefits.

???? Next session: Part 4 will discuss reconstruction techniques and advanced lymph node navigation strategies.

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