Total and Subtotal Gastrectomy with D2 Lymphadenectomy:Technical Notes

R0 resection remains the only potentially curative treatment for gastric cancer. The extent of the operation depends on tumor location and disease stage. The options for candidates for gastric resection include total, proximal, and distal subtotal gastrectomy. This chapter describes the technical performance of total and distal subtotal gastrectomy by providing a detailed step-by-step guide to both mechanical and manual procedures. Total gastrectomy is a major operation even in the hands of the experienced gastric surgeon. In those patients in whom adequate margins can be obtained, distal subtotal gastrectomy is associated with the same survival as total resection, diminishes perioperative morbidity, and improves quality of life. Since, in our opinion, both total and subtotal gastrectomy should be performed in association with extended lymphadenectomy (D2), we also provide an accurate description of this procedure.