What is distal subtotal gastrectomy?
During the operation, the distal part of the stomach containing the disease is removed with adequate proximal and distal resection margins. A *D2 lymph node dissection* is performed at the same time — removal of the regional lymph nodes in line with modern international oncology standards.
After the stomach is removed, the continuity of the digestive tract is restored by reconstruction, most often *Roux-en-Y or Billroth II*, depending on the clinical situation.
Our approach
At MSI, gastric cancer is treated by a multidisciplinary team in line with the guidelines of the *NCCN, ESMO, and the Japanese Gastric Cancer Association*.
Before surgery, every patient undergoes full staging of the disease, including gastroscopy with biopsy, computed tomography, diagnostic laparoscopy when indicated, and other necessary tests. When indicated, treatment begins with neoadjuvant chemotherapy.
Whenever possible, we perform the operation laparoscopically, combining oncological radicality with the advantages of minimally invasive surgery. Postoperative care follows the principles of *ERAS (Enhanced Recovery After Surgery)*.
At MSI, proximal gastrectomy is considered an organ-preserving alternative to total gastrectomy for patients with tumors of the upper third of the stomach, when it is oncologically safe.
Before surgery, the disease is fully staged: gastroscopy with biopsy, computed tomography, and, when indicated, endoscopic ultrasound and diagnostic laparoscopy.
We carefully assess:
- the location of the tumor
- its size
- the distance to the cardia and esophagus
- the risk of lymph node involvement
Whenever possible, the operation is performed laparoscopically. We pay special attention to the choice of reconstruction in order to preserve quality of life and minimize postoperative gastroesophageal reflux.
Postoperative care follows the principles of ERAS (Enhanced Recovery After Surgery).
When is surgery needed?
Distal subtotal gastrectomy is performed for:
- cancer of the gastric antrum
- cancer of the lower third of the stomach body
- certain early forms of gastric cancer
- large benign tumors
- certain GISTs or neuroendocrine tumors when wedge resection is not possible
- complicated precancerous conditions requiring radical treatment
Proximal gastrectomy is performed for:
- early cancer of the upper third of the stomach
- certain localized tumors of the cardia
- some neuroendocrine tumors
- certain GISTs of the upper stomach when wedge resection is not possible
- other localized lesions of the upper stomach
Indications for surgery
Surgery is recommended for:
- localized cancer of the distal stomach
- locally advanced cancer after neoadjuvant therapy
- cases where organ-preserving surgery is impossible
- large benign tumors or tumors in a difficult location
Surgery is recommended for:
- localized tumors of the upper third of the stomach
- no indications for total gastrectomy
- the possibility of achieving adequate oncological resection margins
- a satisfactory functional condition of the patient
How is the operation performed?
The procedure is performed under general anesthesia.
After the stomach is mobilized, a distal resection is performed together with the greater and lesser omentum and a *D2 lymph node dissection*. The continuity of the digestive tract is then restored with a gastrojejunal or gastroduodenal anastomosis, depending on the chosen method of reconstruction.
The removed specimen is always sent for histopathological examination.
The procedure is performed under general anesthesia.
After the stomach and lower esophagus are mobilized, the proximal part of the stomach is resected together with the regional lymph nodes. The digestive tract is then reconstructed — most often with an esophagogastric anastomosis with an anti-reflux modification or a Roux-en-Y reconstruction.
The removed specimen is always sent for histopathological examination.
Advantages of laparoscopic surgery
- Less surgical trauma
- Less postoperative pain
- Faster return to physical activity
- Lower risk of postoperative complications
- Shorter hospital stay
- Better cosmetic result
- Full oncological radicality in line with international standards
- Less surgical trauma
- Less postoperative pain
- Faster return to physical activity
- Shorter hospital stay
- Better cosmetic result
- Preservation of part of the stomach and its function
Recovery after surgery
Postoperative treatment follows the *ERAS* program. Eating is resumed gradually, starting with small amounts of food. Patients receive individual recommendations on their new eating pattern and undergo regular oncological follow-up.
After surgery, eating is resumed gradually. Patients receive individual recommendations on frequent small meals, portion sizes, and reflux prevention.
Because part of the stomach is preserved, many patients adapt nutritionally better than after total gastrectomy.
Our advantages
- Specialization in oncological gastric surgery
- D2 lymph node dissection in line with international standards
- Preferential use of the laparoscopic approach
- Modern techniques for reconstructing the digestive tract
- A multidisciplinary approach to treatment
- Adherence to NCCN, ESMO, and Japanese Gastric Cancer Association guidelines
- Enhanced recovery program (ERAS)
- An organ-preserving approach for tumors of the upper stomach
- Modern laparoscopic technology
- Individual choice of reconstruction
- Oncological radicality in line with international standards
- A multidisciplinary approach to treatment
- Adherence to NCCN, ESMO, and Japanese Gastric Cancer Association guidelines
- Enhanced recovery program (ERAS)
Frequently Asked Questions
In subtotal gastrectomy, only the lower part of the stomach is removed, while the upper part is preserved. This helps preserve digestive function better, provided the operation is oncologically safe.
Yes. In radical treatment of gastric cancer, D2 lymph node dissection is the international standard and achieves optimal oncological results.
In many cases, yes. The final decision depends on the stage of the disease, the location of the tumor, and the patient's individual characteristics.
After part of the stomach is removed, frequent small meals are recommended. Most patients gradually adapt to the new routine and return to an active life.
It depends on the final histopathology report and the stage of the disease. The further strategy is determined by the multidisciplinary team individually for each patient.
During the operation, the cardia, the upper part of the stomach body, and the adjacent part of the esophagus are removed, if necessary to achieve an adequate resection margin. A lymph node dissection is performed at the same time in line with modern oncology standards. After the upper part of the stomach is removed, the continuity of the digestive tract is restored with a reconstruction that allows food to pass and, whenever possible, reduces the risk of reflux.
In proximal gastrectomy, only the upper part of the stomach is removed, while the lower part is preserved. This may help preserve digestive function and nutritional status better.
No. It depends on the location and extent of the tumor and on whether radical treatment with adequate resection margins can be performed.
Yes, there is a risk of reflux. That is why the choice of reconstruction is very important, and we use techniques aimed at minimizing it.
Yes. For malignant tumors, lymph node dissection is performed in line with modern oncology standards.