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Last updated: 16-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
In short
Stomach cancer spreads first to lymph nodes that sit along the stomach’s own arteries. The operation removes those nodes with the stomach, in one piece.
D1 means the first ring of nodes, right on the stomach. D2 adds a second ring along the larger arteries behind the stomach, above the pancreas.
The robot does not change which nodes are removed. Its wristed tools help most in the hard area above the pancreas, where a gentle touch matters.
Lymph node removal is one step of stomach cancer surgery. The full picture, from staging to choosing the operation, is on the main robotic stomach cancer surgery in Ahmedabad page.
Lymph nodes are small filters along the body’s drainage channels. Cancer cells from the stomach can travel along these channels and settle in the nodes. The nodes lie next to the arteries that feed the stomach. So the surgeon follows each artery back towards its start and removes the nodes along it.
This does two jobs. It removes cancer that may already sit in the nodes. It also lets the pathologist examine every node. That report sets the final stage and guides treatment after surgery.
Where the tumour sits decides how much stomach is removed. It also decides which node groups must come out.
| Part | Where it is | What it changes |
|---|---|---|
| Cardia | Just below the join with the food pipe. | A tumour here is assessed as a junction cancer. |
| Fundus | The top dome, under the left diaphragm. | It may need an upper or a total operation. |
| Body | The middle part. | The choice is between removing part or all of the stomach. |
| Antrum | The lower part, before the outlet. | Usually the lower part of the stomach is removed. |
| Pylorus | The outlet valve into the duodenum. | It sets the lower cut edge. |
Cutting an artery near its start, not halfway along, lets the surgeon lift the whole chain of nodes beside it in one piece.
| Artery | What it feeds | What happens to it |
|---|---|---|
| Left gastric artery | The inner curve and the lower food pipe. | Divided at its start in a D2 operation. |
| Right gastric artery | The lower inner curve. | Divided at its start when the lower stomach is removed. |
| Right gastroepiploic artery | The lower outer curve. | Divided when the lower stomach is removed. Kept when only the upper stomach is removed. |
| Left gastroepiploic artery | The upper outer curve. | Divided in a total or upper operation. Kept when only the lower part is removed. |
| Short gastric vessels | The top of the stomach, from the spleen artery. | Divided in a total or upper operation. |
Surgeons use the Japanese Gastric Cancer Association map. It gives each node group a number, called a station. Stations 1 to 7 sit right on the stomach. Removing them is a D1 operation.
The second ring lies along bigger arteries. These run behind the stomach, above the pancreas and towards the liver and spleen. Adding them makes a D2 operation.
| Tumour site | First ring (D1) | Added in D2 |
|---|---|---|
| Lower stomach | Stations 1, 3, 4sb, 4d, 5, 6 and 7. | Stations 8a, 9, 11p and 12a. Sometimes 14v. |
| Middle stomach | Stations 1, 3, 4sa, 4sb, 4d, 5, 6 and 7. | Stations 8a, 9, 10, 11p, 11d and 12a. |
| Upper stomach | Stations 1, 2, 3, 4sa, 4sb and 7. | Stations 8a, 9, 10, 11p and 11d. Lower chest nodes for a junction cancer. |
In plain words, a tumour in the lower stomach does not need the nodes at the spleen. A tumour in the upper stomach does.
D2 is the standard when stomach cancer has grown into the muscle wall or reached the nodes, and has not spread to distant organs.
| Situation | Usual plan |
|---|---|
| Grown to the muscle layer or deeper, or nodes involved, with no distant spread. | D2. |
| After chemotherapy given before surgery. | D2 of the same area, even if the nodes have shrunk. |
| A very early cancer in the inner lining that meets the endoscopic criteria. | Removal through the endoscope, called ESD. No D2. |
| Very frail, or severe heart or lung disease. | D1, sometimes with one or two second-ring stations. |
| Spread to the abdominal lining or distant organs. | No D2. A limited operation only for bleeding or blockage. |
Three things are not added as a routine. Nodes beside the aorta are left unless bulky ones shrink well after chemotherapy. The thin lining behind the stomach, the bursa, is not stripped. The spleen is kept, unless the cancer reaches it or the nodes at its root are bulky. Trials found these extra steps added problems without adding benefit.
Before surgery, a contrast CT is done in two phases, one for arteries and one for veins. The surgeon and the radiologist read it together. This is done for every stomach cancer operation.
For a larger tumour, a short keyhole look inside the abdomen may come first. A saline wash of the lining is checked for cancer cells. If cells are found, the plan changes before any major operation.
Stations 7, 8a, 9 and 11p sit on and above the pancreas. This is the hardest part of the node removal. With straight keyhole tools, the pancreas often has to be pressed to reach these nodes. That pressure can cause a leak of pancreatic fluid after surgery.
Robotic instruments bend at the wrist, and a steady extra arm holds tissue. So the surgeon can lift the node packet off the pancreas instead of pushing on it. Bipolar sealing tools in both hands seal tissue with little heat spread.
With the robot, the gain is a gentler dissection above the pancreas. That means fewer pancreatic leaks. It does not mean a smaller operation.
The advantage grows with harder work. That includes a total or upper operation, bulky nodes above the pancreas, or a heavy build. For a small early tumour in the lower stomach, keyhole surgery already does well. Most of the evidence comes from early cancers in Japan and Korea. A benefit in advanced cancer is likely, but trials have not yet proved it. A standard, audited method is what gave the good results, not the machine alone.
Robotic surgery removes as many nodes as open or keyhole surgery. Long-term cancer results look the same across the three routes.
At the operating table, the removed stomach is laid out. The nodes are separated and labelled by station before they go to the laboratory. This helps the pathologist find every node. Enough nodes must be examined for the stage to be reliable. The report then says how many nodes held cancer. That guides any chemotherapy after surgery.
These are named in words here. Your own figures are discussed at the consent meeting.
No. D1 and D2 describe the nodes. How much stomach is removed depends on where the tumour sits.
Usually not. The spleen is kept unless the cancer reaches it, or the nodes at its root are bulky.
No. Robotic surgery removes as many nodes as open or keyhole surgery. A smaller node removal is not the aim.
No. A very early cancer may be removed through the endoscope. A very frail person may have a D1 operation.
It maps the arteries and veins. Some people have an artery to the liver from the stomach artery, and it must be kept.
Stomach cancer surgery at this centre is covered on the robotic stomach cancer surgery page. The operations themselves are on the robotic distal gastrectomy and robotic total gastrectomy pages. For questions before you travel, call +91-63590-11009.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of scans and biopsy reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Has your surgeon written D1 or D2 on your plan? The endoscopy, biopsy and CT reports can be sent ahead on WhatsApp, so the visit starts with them already read. The extent of your operation is decided at the consultation, after examination. Call +91-63590-11009 Send reports before your visit
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