Question:hard
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?
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?
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Resectable cancer invading a neighbour means en bloc removal of both, no more than needed.
Updated On: Jun 24, 2026
- Closure of the abdomen
- Antrectomy and vagotomy
- Partial gastrectomy and distal pancreatectomy
- Partial gastrectomy, distal pancreatectomy and splenectomy
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The Correct Option is C
Solution and Explanation
Frame this as a staging-versus-operability decision. Imaging called the tumour confined, but the surgeon's eye at laparotomy is the final word, and it shows the antral cancer growing straight into the pancreas out to the tail. Direct contiguous invasion is locally advanced disease, yet it is still curable if you can lift out everything involved in one piece.
The governing rule for gastric cancer touching a neighbouring organ is en bloc extended resection aiming for clear (R0) margins. You do not peel the tumour off the pancreas, you take the involved pancreas with the stomach. Since the involvement runs through the body and tail, the matching pancreatic resection is a distal pancreatectomy, combined with a partial (subtotal) gastrectomy for the antral primary.
Why not the others. Simply closing up assumes inoperability, but there is no metastasis and the lesion is resectable, so abandoning surgery is wrong. Antrectomy with vagotomy is ulcer surgery and would ignore the pancreatic extension. Tacking on a splenectomy is only justified when the spleen or its hilar nodes are involved, which the stem does not describe, so it adds morbidity without benefit here.
$\text{en bloc R0 resection} = \text{partial gastrectomy} + \text{distal pancreatectomy}$
\[\boxed{\text{Partial gastrectomy and distal pancreatectomy}}\]
The governing rule for gastric cancer touching a neighbouring organ is en bloc extended resection aiming for clear (R0) margins. You do not peel the tumour off the pancreas, you take the involved pancreas with the stomach. Since the involvement runs through the body and tail, the matching pancreatic resection is a distal pancreatectomy, combined with a partial (subtotal) gastrectomy for the antral primary.
Why not the others. Simply closing up assumes inoperability, but there is no metastasis and the lesion is resectable, so abandoning surgery is wrong. Antrectomy with vagotomy is ulcer surgery and would ignore the pancreatic extension. Tacking on a splenectomy is only justified when the spleen or its hilar nodes are involved, which the stem does not describe, so it adds morbidity without benefit here.
$\text{en bloc R0 resection} = \text{partial gastrectomy} + \text{distal pancreatectomy}$
\[\boxed{\text{Partial gastrectomy and distal pancreatectomy}}\]
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