Question

An adult presented with hematemesis and upper abdominal pain. Endoscopy revealed a growth at the pyloric antrum of the stomach. CT scan showed growth involving the pyloric antrum without infiltration or invasion into surrounding structures and no evidence of distant metastasis. At laparotomy the neoplastic growth was observed to involve the posterior wall of the stomach and the pancreas, extending 6 cm up to the tail of the pancreas. What will be the most appropriate surgical management?

• A. Closure of the abdomen
• B. Antrectomy and vagotomy
• C. Partial gastrectomy and distal pancreatectomy
• D. Partial gastrectomy, distal pancreatectomy and splenectomy

Hint:

Resectable cancer invading a neighbour means en bloc removal of both, no more than needed.

Answer 1

The Correct Option is C

Step 1: This is a gastric carcinoma of the antrum that, at laparotomy, is found to directly invade an adjacent organ (the pancreas, up to the tail). There is no distant metastasis. Direct invasion of a contiguous organ is a T4b lesion, not a contraindication to surgery, provided an en bloc resection can clear it.
Step 2: The principle for locally advanced gastric cancer invading a neighbouring organ is en bloc resection: remove the involved stomach together with the directly invaded organ in one specimen to achieve R0 margins. Here that means partial (subtotal) gastrectomy plus distal pancreatectomy to take the tumour and the invaded pancreatic body and tail together.
Step 3: Closure of the abdomen (option A) is wrong because there is no unresectable distant disease or peritoneal spread; the lesion is resectable.
Step 4: Antrectomy and vagotomy (option B) is an operation for peptic ulcer disease, not for an invasive cancer, and it would leave the pancreatic disease behind.
Step 5: Adding splenectomy (option D) is not automatically required just because a distal pancreatectomy is done. Splenectomy is added only if the spleen or splenic hilum nodes are involved; here the disease stops at the pancreatic tail without stated splenic involvement, so routine splenectomy is overtreatment in this stem.
Conclusion: The correct answer is C. Partial gastrectomy and distal pancreatectomy.