Each patient was assessed by a consultant member of the team in the preoperative clinic and a management plan established. Every Friday afternoon, all investigations were available for discussion by the consultant surgeons and junior staff as well as radiologists and endoscopists. In this way an exact preoperative diagnosis was made and an appropriate operation planned. Laparoscopy was rarely used as a diagnostic technique and was used mainly to detect peritoneal seeding where this was not apparent preoperatively. Some of the finest operating I have yet seen was in the National Cancer Center Hospital.
Peritoneal cytology is performed routinely for all advanced gastric cancers.
I saw a number of D2 and D3 gastrectomies. The quality of lymphatic dissection and clearance was beyond compare. Equally important was the ability to be patient. Lymphatic clearance takes time. The excised specimen is opened and carefully examined in theatre by the operating consultant.