Total gastrectomy and gastrointestinal reconstruction
- Debrah Wirtzfeld, MD, MSc, FRCSC, FACS
Debrah Wirtzfeld, MD, MSc, FRCSC, FACS
- Associate Professor of Surgery, Oncology, Community Health Sciences and Biochemistry & Medical Genetics
- University of Manitoba
- Pamela Hebbard, MD, FRCS
Pamela Hebbard, MD, FRCS
- Assistant Professor of Surgery
- University of Manitoba
The term “total gastrectomy” implies the complete removal of all gastric tissue. Total gastrectomy is the treatment of choice for certain gastric tumors.
Perioperative considerations, surgical techniques for total gastrectomy and gastrointestinal reconstruction, and complications of total gastrectomy are reviewed here. Issues pertaining to partial gastrectomy are discussed elsewhere. (See "Partial gastrectomy and gastrointestinal reconstruction".)
The gastroesophageal junction refers to the point of transition from the abdominal esophagus to the proximal stomach. Carcinomas arising at or near the gastroesophageal junction pose unique challenges, both in their ability to arise from esophageal or gastric mucosa, and in the complexity of jointly resecting the esophagus and stomach. Gastroesophageal junction tumors are reviewed elsewhere. (See "Multimodality approaches to potentially resectable esophagogastric junction and gastric cardia adenocarcinomas".)
SURGICAL ANATOMY AND PHYSIOLOGY OF THE STOMACH
The surgical anatomy of the stomach, including the anatomic divisions of the stomach (cardia, fundus, body, antrum, and pyloric sphincter (figure 1)), blood supply, and lymphatic drainage, is reviewed elsewhere (figure 2). (See "Partial gastrectomy and gastrointestinal reconstruction", section on 'Surgical anatomy and physiology of the stomach'.)
Total gastrectomy is indicated in the treatment of certain gastric tumors. These include:
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- SURGICAL ANATOMY AND PHYSIOLOGY OF THE STOMACH
- TUMOR STAGING
- Staging laparoscopy
- PREOPERATIVE PREPARATION
- Medical risk assessment
- Bowel preparation and decontamination
- GENERAL CONSIDERATIONS
- Open versus laparoscopic total gastrectomy
- Margins of resection
- Extent of nodal dissection
- - Gastric adenocarcinoma
- - GIST tumor
- - Type III gastric carcinoid
- - Prophylactic gastrectomy
- Vagus nerve preservation
- Total gastrectomy
- Gastrointestinal reconstruction
- Feeding jejunostomy
- POSTOPERATIVE MANAGEMENT AND FOLLOW-UP
- Perioperative nutritional support
- PERIOPERATIVE MORBIDITY AND MORTALITY
- Anastomotic complications
- Postgastrectomy syndromes
- SUMMARY AND RECOMMENDATIONS