Radical surgery for cardia carcinoma: total gastrectomy, D2 + No.10 dissection, esophagojejunal Roux-en-Y anastomosis

A 71-year-old man with cardia carcinoma (cT4NxM0) suggested was scheduled for a primary radical resection of the lesion. Intraoperative exploration revealed no ascites, no suspicious palpable metastatic nodes in the pelvic cavity, liver, small intestine/colon, or the mesentery; the tumor, an ulcerated mass of about 10 cm × 8 cm, was located in the cardia, involving the body of the stomach; enlarged lymph nodes were palpable at the lesser curvature side. A Kocher incision was made for exploration, which showed enlargement of station 12b lymph nodes, though no metastasis was indicated by frozen section pathology. No obvious enlargement of station 16 lymph nodes was detected. A radical surgery was then planned, and routine total gastrectomy with D2 lymph node dissection was performed. Due to the nature of proximal advanced gastric cancer, the spleen and the pancreatic body and tail were isolated retroperitoneally, and pulled outside the abdominal cavity for dissection of lymph node stations 4sa, 10, 11d, and 4sb. Esophagojejunal anastomosis was then performed routinely on a Roux-en-Y loop. The postoperative recovery was uneventful. Imaging of the anastomosis showed no complication four days after the surgery, and a regular diet was resumed gradually. Postoperative chemotherapy was delivered from the third week after surgery using the DOF regimen. The patient was in a satisfactory general condition eight months after surgery, without signs of recurrence or metastasis.