Why do a total gastrectomy rather than partial for cancerous tumor?

A total gastrectomy, also known as a complete gastrectomy, involves the surgical removal of the entire stomach. It is typically performed to treat advanced or extensive stomach cancer that cannot be adequately managed with less invasive procedures such as partial gastrectomy or local tumor resection.

There are several reasons why a total gastrectomy may be preferred over a partial gastrectomy for cancerous tumors:

1. Extent of tumor involvement: A total gastrectomy is often chosen when the tumor is widespread or involves a significant portion of the stomach. This may occur in advanced stages of stomach cancer or when the tumor has invaded nearby structures. By removing the entire stomach, surgeons can ensure complete tumor removal and reduce the risk of residual cancer cells.

2. Greater likelihood of achieving negative margins: Negative margins refer to the absence of cancerous cells at the edges of the resected tissue. Achieving negative margins is crucial to prevent tumor recurrence. In cases where the tumor is extensive or has invaded the surrounding tissues, a total gastrectomy provides a better chance of obtaining clear margins compared to a partial gastrectomy.

3. Lymph node involvement: Stomach cancer often spreads to nearby lymph nodes. During a total gastrectomy, the surgeon can remove the lymph nodes in the vicinity of the stomach, including those along the greater and lesser curvature of the stomach, as well as the perigastric, celiac, and para-aortic lymph nodes. This thorough lymph node dissection helps in staging the cancer and reduces the risk of tumor spread.

4. Palliation and symptom control: In advanced stages of stomach cancer, a total gastrectomy may be performed as a palliative measure to alleviate symptoms and improve quality of life. By removing the stomach and associated tumor mass, it can help relieve symptoms such as pain, nausea, vomiting, and difficulty swallowing.

However, the decision to perform a total gastrectomy or a partial gastrectomy is individualized for each patient based on various factors, such as the stage and location of the tumor, the patient's overall health, and the potential complications of surgery. A partial gastrectomy may be preferred in certain situations, such as early-stage tumors confined to a localized area of the stomach or when there are specific concerns regarding the patient's ability to tolerate a total gastrectomy.

The choice between total and partial gastrectomy is made by a multidisciplinary team of healthcare professionals, including surgeons, oncologists, radiologists, and other specialists, based on a comprehensive evaluation of the patient's condition and a thorough discussion of the risks, benefits, and alternatives of each surgical approach.