✦ STOMACH CANCER · SURGICAL RESECTION

Subtotal Gastrectomy

Q: Can I eat normally after subtotal gastrectomy?

Yes, preserving the proximal stomach allows better nutrition. Patients adapt to smaller, more frequent meals over 3–6 months. Vitamin B12 injections are required lifelong.

Q: What is D2 lymphadenectomy?

D2 removes the perigastric lymph nodes (D1) plus the nodes along the coeliac axis, hepatic artery, and splenic artery, maximising staging accuracy and cancer clearance.

Q: When does adjuvant chemotherapy start after subtotal gastrectomy?

Adjuvant FLOT chemotherapy starts 4–6 weeks after surgery once the patient has made adequate recovery. Four post-operative cycles are given.

Removal of the distal stomach with D2 lymphadenectomy for distal gastric cancer — preserving the proximal stomach.

180–300 Min TREATMENT DURATION

6–10 Days CARE SETTING

Open APPROACH

6–8 Weeks RECOVERY TIMELINE

What is Subtotal Gastrectomy?

Subtotal (distal) gastrectomy removes the distal two-thirds of the stomach — antrum, body, and pylorus — along with D2 systematic lymph node dissection and the omentum. It is the standard surgical treatment for cancers of the antrum and distal stomach, preserving the proximal gastric remnant for better nutritional outcomes. Dr. Tagore Mohan Grandhi performs subtotal gastrectomy with D2 lymphadenectomy, the oncological standard providing complete cancer clearance and maximum lymph node harvest. All cases are reviewed at MDT before surgery.

Suitable for patients with resectable gastric adenocarcinoma of the antrum, body, or distal stomach where a proximal margin can be achieved while preserving the upper gastric remnant.

How the Procedure Works

Staging Laparoscopy

Diagnostic laparoscopy performed to exclude peritoneal metastases not visible on CT before proceeding with resection.

D2 Lymphadenectomy

Systematic removal of perigastric lymph nodes along the left gastric artery, coeliac axis, and splenic artery.

Gastric Transection

Stomach transected at the proximal margin with clear oncological margins. Duodenum divided just distal to pylorus.

Reconstruction

Roux-en-Y or Billroth II gastrojejunostomy performed. Roux-en-Y preferred to minimise bile reflux symptoms.

Recovery and Adjuvant

Post-operative diet progressed over 5–7 days. Adjuvant FLOT chemotherapy commenced 4–6 weeks post-operatively.

Outcomes

180–300 MinTREATMENT DURATION

6–10 DaysCARE SETTING

OpenAPPROACH

6–8 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→Preserves the proximal stomach — better nutritional outcomes than total gastrectomy
→D2 lymphadenectomy provides optimal cancer staging and clearance
→Combined with FLOT chemotherapy significantly improves overall survival
→Roux-en-Y reconstruction minimises bile reflux symptoms post-operatively

D2 lymphadenectomy is the cornerstone of gastric cancer surgery. Combined with perioperative FLOT chemotherapy, subtotal gastrectomy offers the best available chance of cure for resectable distal gastric cancer.

— Dr. Tagore Mohan Grandhi, Senior Consultant Gastrointestinal Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

Can I eat normally after subtotal gastrectomy?+

What is D2 lymphadenectomy?+

When does adjuvant chemotherapy start after subtotal gastrectomy?+

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