Gastrectomy Questions

Q What is not true about lymph node dissection in stomach cancer?

a) D1 dissection includes only the perigastric lymph nodes?

b) D1 dissection is resection of lymph nodes 1-6

c) D2 dissection includes station 7-11

d) D2 dissection removes lymph nodes with in the porta hepatis?

Q2. Which of the following statements regarding gastric cancer are true?

a) Extended organ resections including spleen, pancreas and transverse colon have added survival advantage

b) A minimal of 15 lymph nodes should be resected for it to be termed as sufficient nodal clearance

c) Total gastrectomy have added benefits over partial gastrectomy

d) Gastrectomy should also be considered for palliation in patients with ascites

Answer

1) d

D2 gastrectomy includes lymph nodes along the common hepatic, left gastric, celiac and splenic artery.

Stations 12-16 come under D3 gastrectomy which include porta hepatis and adjacent to aorta.

2) b

The Dutch and British trials have shown that removing organs like spleen and pancreas have no added survival advantage and add to the morbidity

15 is the number of lymph nodes accepted as complete nodal clearance

Total gastrectomy has no added advantage if a margin of 4-6 cm on either side of the tumor is there

In incurable diseases surgery is best avoided.