D2 surgery for a gastric cancer patient after neoadjuvant chemotherapy

This video demonstrates the surgical procedure for a gastric cancer patient who had responded well to pre-operative chemotherapy. Gastric cancer was pre-operatively confirmed by endoscopy. CT showed that the distal gastric cancer directly invaded the head of the pancreas and meanwhile was associated with metastasis in lymph node stations 3, 6, 7, 8, 9, and 11p. The pre-operative pathological stage was T4bN2M0. The patient responded well to pre-operative chemotherapy. Post-chemotherapy CT showed that a gap appeared between the cancer and the head of the pancreas and the lymph node metastases disappeared. D2 surgery was then performed. Surgical features: the metastatic lymph nodes located at vital sites before chemotherapy as well as the primary tumor may form scar tissues after necrosis and cover the major organs and vessels. The disappearance of the metastatic lymph nodes on CT can not rule out the possibility of cancer, which may be detected by pathology. Therefore, these lymph nodes must be dissected. The surgical operation is challenging.