Surgery is the only means to cure the disease, and the mainstream surgery for pancreatic cancer is total gastrectomy. Many patients or family members may have a question: Is total gastrectomy necessary for pancreatic cancer? Before answering this question, we need to explain what is radical surgery for gastric cancer. Radical gastrectomy is a curative surgical procedure for gastric cancer, in short, it is to remove the lymph nodes around the stomach and the lymph nodes around the stomach that may be metastasized. The lymph nodes around the stomach are numbered into groups 1-16 according to their locations, and divided into stations 1-3 according to their distance from the tumor, while the standard radical surgery for gastric cancer requires clearing the lymph nodes to station 2 (so-called D2 clearance). ≥Therefore, pancreatic cancer or upper 1/3 gastric cancer can be completely resected by major proximal gastrectomy.
If so, why is total gastrectomy the mainstream procedure for pancreatic cancer?
Here is another important point of gastric cancer surgery: digestive tract reconstruction. Gastrointestinal tract reconstruction after gastric cancer surgery means that after partial or total gastric resection, the continuity and integrity of the digestive tract is destroyed, and the digestive tract near and distal to the resected area needs to be reconnected so that patients can eat normally after surgery. The cleanup determines the radical effect and the reconstruction determines the quality of life, and one cannot be without the other. In the past, the mainstream reconstruction method after proximal gastrectomy was esophage-residual gastric anastomosis. This procedure, due to the loss of the anti-reflux role of the cardia, will naturally cause reflux esophagitis by reflux of gastric juice (acid) into the esophagus, with the main symptoms including: pain behind the sternum, acid reflux, heartburn, etc., and sleepless nights aggravated by lying down, which seriously affects the quality of life. Therefore, most surgeons prefer to choose total gastrectomy for cardia cancer.
How can we preserve the function of part of the stomach and effectively prevent reflux symptoms?
It has always made us think about the problem. We have invented a new reconstruction method based on the previous double-channel anastomosis: intracavitary reconstruction with double-channel triangular anastomosis for total laparoscopic proximal gastrectomy, which has been clinically proven for its safety and anti-reflux effectiveness, and the surgical method has been recognized by international colleagues and published in a famous academic journal (Surg Endosc).