"Total gastrectomy may be indicated in treating extensive stomach malignancies. This radical procedure is not performed when carcinoma with distant metastasis to the liver or pouch of Douglas or seeding throughout the peritoneal cavity is present. It may be performed in association with the extirpation of adjacent organs, such as the spleen, body and tail of the pancreas, a portion of the transverse colon, and so forth. It is also the procedure of choice in controlling the intractable ulcer diathesis associated with non-beta islet cell tumors of the pancreas when pancreatic tumor or metastases remain that cannot be controlled medically".
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