How to identify early complications in patients undergoing distal gastrectomy?

Table 1 T staging system proposed by the Union for International Cancer Control and the American Joint Committee on Cancer

T category definitions
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ: Intraepithelial tumor without invasion of the lamina propria
T1	Tumor invades lamina propria, muscularis mucosae, or submucosa
T1a	Tumor invades lamina propria or muscularis mucosae
T1b	Tumor invades submucosa
T2	Tumor invades muscularis propria
T3	Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures. T3 tumors also include those extending into the gastrocolic or gastrohepatic ligaments, or into the greater or lesser omentum, without perforation of the visceral peritoneum covering these structures
T4	Tumor invades serosa (visceral peritoneum) or adjacent structures
T4a	Tumor invades serosa (visceral peritoneum)
T4b	Tumor invades adjacent structures such as spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum

Table 2 Anatomical definitions of lymph node stations

Station	Definition
1	Right paracardial lymph nodes, including those along the first branch of the ascending limb of the left gastric artery
2	Left paracardial lymph nodes including those along the esophago-cardiac branch of the left subphrenic artery
3	3a Lesser curvature lymph nodes along the branches of the left gastric artery
	3b Lesser curvature lymph nodes along the 2nd branch and distal part of the right gastric artery
4	4sa Left greater curvature lymph nodes along the short gastric arteries (perigastric area)
	4sb Left greater curvature lymph nodes along the left gastroepiploic artery (perigastric area)
	4d Right greater curvature lymph nodes along the 2nd branch and distal part of the right gastroepiploic artery
5	Suprapyloric lymph nodes along the 1st branch and proximal part of the right gastric artery
6	Infrapyloric lymph nodes along the first branch and proximal part of the right gastroepiploic artery down to the confluence of the right gastroepiploic vein and the anterior superior pancreatoduodenal vein
7	Lymph nodes along the trunk of left gastric artery between its root and the origin of its ascending branch
8	8a Anterosuperior lymph nodes along the common hepatic artery
	8p Posterior lymph nodes along the common hepatic artery
9	Coeliac artery
10	Splenic hilar lymph nodes including those adjacent to the splenic artery distal to the pancreatic tail, and those on the roots of the short gastric arteries and those along the left gastroepiploic artery proximal to its 1st gastric branch
11	11p Proximal splenic artery lymph nodes from its origin to halfway between its origin and the pancreatic tail end
	11d Distal splenic artery lymph nodes from halfway between its origin and the pancreatic tail end to the end of the pancreatic tail
12	12a Hepatoduodenal ligament lymph nodes along the proper hepatic artery, in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
	12b Hepatoduodenal ligament lymph nodes along the bile duct, in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
	12p Hepatoduodenal ligament lymph nodes along the portal vein in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas
13	Lymph nodes on the posterior surface of the pancreatic head cranial to the duodenal papilla
14	Lymph nodes along the superior mesenteric vein
15	Lymph nodes along the middle colic vessels
16	16a1 Paraaortic lymph nodes in the diaphragmatic aortic hiatus
	16a2 Paraaortic lymph nodes between the upper margin of the origin of the celiac artery and the lower border of the left renal vein
	16b1 Paraaortic lymph nodes between the lower border of the left renal vein and the upper border of the origin of the inferior mesenteric artery
	16b2 Paraaortic lymph nodes between the upper border of the origin of the inferior mesenteric artery and the aortic bifurcation
17	Lymph nodes on the anterior surface of the pancreatic head beneath the pancreatic sheath
18	Lymph nodes along the inferior border of the pancreatic body
19	Infradiaphragmatic lymph nodes predominantly along the subphrenic artery
20	Paraesophageal lymph nodes in the diaphragmatic esophageal hiatus

Table 3 Extent of systematic lymphadenectomy in distal gastrectomy

Lymph nodes dissection	Lymph node station, n
D0	Lymphadenectomy less than D1
D1	1, 3, 4sb, 4d, 5, 6 and 7
D1+	1, 3, 4sb, 4d, 5, 6, 7, 8a and 9
D2	1, 3, 4sb, 4d, 5, 6, 7, 8a, 9, 11p and 12a

D: Extent of lymph nodes dissection.