Grading of radical gastrectomy

Radical gastrectomy for gastric cancer is divided into different grades such as D0, D1, D2 and D3. The indications, surgical difficulty and postoperative complications of each grade of operation are different. The specific selection should comprehensively consider the tumor condition and the patient's physical condition. Auxiliary treatment and regular reexamination are also needed after operation. Radical gastrectomy is one of the main methods for the treatment of gastric cancer. According to the complexity of surgery and the scope of lymph node dissection, it can be divided into D0, D1, D2, D3 and other different grades. There are differences in indications, surgical difficulty and postoperative complications among different grades of radical gastrectomy. The following are related contents about the classification of radical gastrectomy: 1. D0 Radical gastrectomy: Scope of operation: only resection of primary gastric lesion, no lymph node dissection. Indication: early gastric cancer, tumor confined to mucosa or submucosa, no lymph node metastasis. Postoperative complications: few, mainly including hemorrhage, infection, etc. 2. D1 Radical gastrectomy: Scope of operation: Resection of the primary gastric lesion and some tissues around the stomach, including the lesser omentum, paragastric left artery, parahepatic common artery, splenic hilum and lymph nodes in the left and right regions of the cardia. Indication: gastric cancer invading the submucosa, no lymph node metastasis or a few regional lymph node metastasis (N1). Postoperative complications: Compared with D0 radical gastrectomy, it is slightly higher, and complications such as anastomotic fistula and intestinal obstruction may occur. 3. D2 radical gastrectomy: surgical scope: resection of primary gastric lesion and most tissues around stomach, including lymph nodes around left gastric artery, common hepatic artery and splenic artery. Indication: Gastric cancer invades muscular layer or serosa layer, and there are many regional lymph node metastases (N2). Postoperative complications: many, such as anastomotic fistula, intestinal obstruction, bleeding, infection, etc., serious cases may lead to death. 4. D3 Radical gastrectomy: Scope of operation: Resection of the primary focus of the stomach and all tissues around the stomach, including pancreatic capsule, anterior lobe of transverse mesocolon, spleen, etc. Indications: gastric cancer invasion of adjacent tissues or organs, distant lymph node metastasis (N3). Postoperative complications: extremely high, such as anastomotic fistula, intestinal obstruction, bleeding, infection, organ failure, etc., mortality is high. It should be noted that the grade of radical gastrectomy for gastric cancer should be comprehensively considered according to factors such as tumor size, location, depth of invasion, lymph node metastasis, etc. At the same time, adjuvant therapy such as chemotherapy and radiotherapy should be performed after surgery to improve the treatment effect and survival rate. In addition, for the elderly and patients with other diseases, the risk of surgery is high, and a comprehensive assessment needs to be made before surgery to develop an individualized treatment plan. At the same time, patients also need to pay attention to diet and rest after surgery to promote recovery. In short, the classification of radical gastrectomy for gastric cancer is determined according to the scope and difficulty of the operation. The indications and postoperative complications of different grades of radical gastrectomy for gastric cancer are different. When selecting the surgical grade, the patient's condition and physical condition should be comprehensively considered to formulate an individualized treatment plan. At the same time, adjuvant therapy and regular reexamination are needed after surgery to improve the treatment effect and survival rate.