Gastric Cancer — Surgical

According to the Japanese classification, which TNM stage of gastric cancer is defined by invasion limited to the mucosa or submucosa, regardless of lymph node involvement?

A 62-year-old woman undergoes distal gastrectomy with D2 lymphadenectomy for T3N2 gastric cancer of the antrum. Intraoperatively, the tumor is found to directly invade the pancreatic head. The surgeon performs an en bloc distal pancreatectomy along with splenectomy to achieve R0 resection. Postoperatively, the patient develops severe hyperglycemia (fasting glucose 320 mg/dL) and steatorrhea. What is the most likely cause of these complications?

A 58-year-old man from rural India presents with progressive dysphagia and early satiety. Upper endoscopy reveals a large ulcerated lesion in the stomach. Biopsy confirms adenocarcinoma. What is the most common histological type of gastric cancer?

A 58-year-old man from rural Maharashtra presents with a 4-month history of progressive dysphagia, early satiety, and weight loss of 8 kg. Upper endoscopy reveals a 5 cm ulcerated lesion in the gastric antrum with irregular margins. Biopsies confirm adenocarcinoma. CT staging shows a T3N2M0 tumour with no distant metastases. The patient is fit for surgery with normal renal and hepatic function. What is the most appropriate next step in management?

A 62-year-old woman from Delhi undergoes subtotal gastrectomy with D2 lymphadenectomy for a T2N1M0 gastric adenocarcinoma of the antrum. Intraoperative findings include a 3.5 cm tumour with 4 positive perigastric lymph nodes and 8 negative distant lymph nodes (total 18 nodes examined). Final histopathology confirms adequate margins (R0 resection) and no involvement of the proximal stomach. The patient recovers well from surgery. What is the most appropriate next step in management?