Laparoscopic D2 Radical Total Gastrectomy for Gastric Cancer

We present the case of a 66-year-old man was examined in our multidisciplinary gastrointestinal oncology clinic for further management of an adenocarcinoma of the body of the stomach. The patient presented to his primary care physician with a five-week history of intermittent chest pressure radiating to his back. Extensive evaluation for a cardiac source was unremarkable, including a normal stress test and cardiac ultrasound. He then developed epigastric vague abdominal pain, and given that he carried a history of prior H. pylori infection in 2003, there was concern that he might have a peptic ulcer. An upper endoscopy was obtained and showed a large ulcerated tumor in the body of the stomach. Pathological examination of biopsy specimens of the stomach ulcer showed moderately to poorly differentiated adenocarcinoma. Staging computed tomography (CT) scans of the chest, abdomen and pelvis only showed prominent lymph nodes adjacent to the lesser curvature of the stomach within the gastrohepatic ligament and no evidence of metastatic disease. A total gastrectomy using laparoscopic approach was performed by Dr. Mocan Lucian at 3-rd Surgery Clinic (Clinica Chirurgie 3) Cluj Napoca.