Prophylactic gastrectomies are performed for patients with hereditary gastric cancer (CDH1 mutation). These patients do not have any visible tumor in most instances, and the surgery is being performed to remove the entire gastric mucosa to prevent any future development of gastric cancer. They are usually sent for intraoperative evaluation of margins.
Please consult Dr. Setia for frozen section analysis (prior to triage) and for all grossing related questions.
Intraoperative (Frozen Section) Evaluation
Objective: To confirm resection of the entire gastric mucosa, meaning, you should see:
- A complete ring of squamous mucosa at the proximal margin
- Only duodenal mucosa (no gastric mucosa) at the distal margin
Triage and Frozen Section:
- Orient the specimen and note proximal and distal margins. At this point, do NOT open the specimen yet.
- Ink margins and remove the staple lines
- Freeze margins en face to ensure histology at each (gross evaluation is NOT adequate)
- If the squamous mucosa at proximal margin OR duodenal mucosa at distal margin is incomplete, the surgeon will need to take more.
- CONTACT DR. SETIA FOR ALL CASES!
- Open the stomach along the greater curvature:
- Photograph the mucosal surface
- Pin the specimen on a wax block and submerge mucosal-side-down in formalin
- Margins: If en face margins were NOT taken intraoperatively, then section perpendicular to the margin and submit entirely
- Submit the rest of the stomach entirely
- A specimen photo should be used as a template or schematic map to identify the exact location of the tissue blocks:
- All lymph nodes should be sampled as per usual protocol for a gastrectomy with tumor