GASTRIC

ADENOCARCINO Kakha Gujabidze

MA
INCIDENCE AND
EPIDEMIOLOGY
RISK FACTORS

Male Gender,Atrophic Gastritis,Menetrieres

disease,H.pylori
Regional Variation Distal (Asia) ; Proximal (Non-
Asian countries)
Distal (Asia) - associated with H. pylori,alcohol
use, high-salt diet, processed meat and low fruit
and vegetable intake
Proximal Obesity,GERD
CLINICAL &
HISTOLOGIC
CLASSIFICATION
oUlcerative - MC
oPolypoid - Intraluminal
oScirrhous Pre Linitis Plastica
oSuperficial Intraluminal
oBorrmann 1926 - oldest
LAUREN
CLASSIFICATION
Intesti Diffus
nal e
Well Poorly
Differentiat Differentiat
ed ed

Enviroment
Familia
al

Gland Signet-ring

Transmural
Hemat.Spr
lymphatic
ead
Spread

Gastric Blood Type

Atrophy A
CLINICAL
PRESENTATION &
EVALUATION
Depends on Stage
Symptoms Vague Epigastric Pain , Weight Loss ,
Dysphagia, Hematemesis , Vomiting
PE focuses on advanced disease signs
Cervical,Supraclavicular (Virchow) and Axillary (Irish)
Nodes,Palpable Umbilical Metastasis(SJN),Rectal shelf
of Blumer
Upper Endoscopy to characterize location & extent
Endoscopic Ultrasound Depth
Laparoscopy Intra-abdominal Spread
CLINICAL
PRESENTATION AND
EVALUATION
STAGING & RISK
ASSESMENT
MANAGEMENT
MANAGEMENT OF
LOCOREGIONAL
DISEASE
Depends of Stage
T1a well differentiated , confined to mucosa ,
<2cm EMR / ESD
T1 Surgery with D1 +
IB III - Radical Gastrectomy -- ( Subtotal if 5 cm
achieved between GE and Tumor )
MANAGEMENT OF
LOCOREGIONAL
DISEASE - LN
D1 Perigastric LNs
D2 Perigastric + those along the left gastric,
common hepatic and splenic arteries and the
coeliac axis
Current trend towards D2
Laparoscopy D2 problem
SPECIFIC SITUATIONS
Metastasectomy
Peritoneal Metastases
Signet-cell Tumours
GASTRIC RESECTION
Vagal Innervation
Principles of Reconstruction
Stapling & Hand-Suturing
Complications
 TYPES
Antrectomy / Hemigastrectomy 35-50 % -
Vagotomy to be performed Midline Incision
Partial
Subtotal - Lower third
Nearly Total
Radical - Upper third
 OVERVIEW OF
APPROACH

Midline Incision
Liver retraction to show GE
Omentum Excision
Ligation of vessels ( Short gastric difficult to
reach potential source of blood loss + left
gastric)
RECONSTRUCTION
BILLROTH I
Pros Preservation of normal anatomy and
function digestive system
- Easier to Perform
- less dumping and afferent loop
Cons Need to mobilize duodenum
- No cancer usage

Angle of Sorrow
BILLROTH II
Pro Low Tension anastomosis
Cons Dumping, Afferent loop , ulcer susceptible
Retro
 ROUX EN Y
pros - fewer problems with efferent/afferent limb
obstruction
cons - erosive ulcer formation still occurs.