✦ STOMACH CANCER · CURATIVE SURGERY

Total Gastrectomy

Q: What dietary changes are needed after total gastrectomy?

Six to eight small meals daily, chewing slowly. Lifelong B12 injections (3-monthly), calcium, vitamin D, and iron supplementation are mandatory.

Q: What is the FLOT chemotherapy regimen?

FLOT (docetaxel, oxaliplatin, leucovorin, 5-FU) — 4 cycles before and 4 after surgery for resectable gastric cancer. Multiple trials confirm significant improvement in overall survival.

Q: What is dumping syndrome after total gastrectomy?

Dumping syndrome — postprandial flushing, sweating, diarrhoea — occurs when food passes too quickly into the jejunum. Managed by eating small frequent meals and avoiding high-sugar foods.

Complete stomach removal with D2 lymphadenectomy — for proximal, multifocal, or diffuse gastric cancer.

240–360 Min TREATMENT DURATION

7–12 Days CARE SETTING

Open APPROACH

8–10 Weeks RECOVERY TIMELINE

What is Total Gastrectomy?

Total gastrectomy removes the entire stomach, omentum, and D2 regional lymph nodes, with Roux-en-Y oesophagojejunal reconstruction. It is required for proximal gastric cancers, gastro-oesophageal junction cancers (Siewert II–III), diffuse (signet ring cell) cancers, and multifocal gastric disease. Dr. Tagore Mohan Grandhi performs total gastrectomy with D2 lymphadenectomy. Perioperative FLOT chemotherapy (4 cycles before and 4 cycles after surgery) is the current standard for resectable gastric cancer.

Suitable for patients with resectable gastric adenocarcinoma of the proximal stomach, gastro-oesophageal junction (Siewert II–III), diffuse-type cancer, or multifocal disease requiring complete stomach resection.

How the Procedure Works

Staging and MDT Planning

CT, EUS, PET-CT, and staging laparoscopy. MDT conference determines perioperative FLOT sequencing before surgery.

Complete Gastric Mobilisation

Entire stomach mobilised with D2 lymphadenectomy at all nodal stations. Spleen preserved unless directly involved.

Gastric Resection

Oesophagus divided above tumour with clear margin. Duodenum divided just distal to pylorus. Stomach removed en-bloc.

Roux-en-Y Reconstruction

Oesophagojejunostomy created with circular stapler. Jejunojejunostomy completes Y-configuration.

Adjuvant Chemotherapy

Four post-operative FLOT cycles commenced at 4–6 weeks. Lifelong B12, calcium, vitamin D, and iron supplementation started.

Outcomes

240–360 MinTREATMENT DURATION

7–12 DaysCARE SETTING

OpenAPPROACH

8–10 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→Curative resection for proximal, GEJ, and diffuse-type gastric cancers
→D2 lymphadenectomy provides optimal oncological staging and disease control
→Perioperative FLOT chemotherapy significantly improves overall survival
→Roux-en-Y reconstruction minimises bile reflux after complete stomach removal

Total gastrectomy with D2 lymphadenectomy and perioperative FLOT is the most complete treatment we can offer for proximal gastric cancer. Every surgical and oncological decision is made together at MDT for each individual patient.

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

Common Questions

Frequently Asked Questions

What dietary changes are needed after total gastrectomy?+

What is the FLOT chemotherapy regimen?+

What is dumping syndrome after total gastrectomy?+

Not sure which treatment is right for you?

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