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Patrick Maguire, MD, Oncology, answeredFortunate patients who have their gastric cancer diagnosed at an early stage may undergo surgery alone. A procedure called a subtotal gastrectomy (SG) usually removes about 70% to 80% of the stomach, the omentum (the fatty, drapelike lining in the abdomen that overlies the stomach), and a portion of the duodenum (first section of the small bowel). According to major randomized controlled trials (RCTs), the 50% to 60% survival rate for patients undergoing SG was essentially the same as patients undergoing total gastrectomy (removal of the entire stomach). Trials have shown that laparoscopic SG has the same cancer control rate as the open SG procedure, but with less blood loss and earlier discharge from the hospital for most patients. A major area of controversy has been the extent of surgical removal of lymph nodes near the stomach. The most recent trials indicate that removal of all of the regional lymph nodes near the stomach (called an extended lymphadenectomy) is indicated, but removal of lymph nodes near the aorta in the back of the abdomen doesn't improve patients' survival.