[Verse 1]
Sixty-two years old, antral adenocarcinoma sits deep,
cT3N1 — transmural spread, one node's lost its sleep,
This ain't early-stage, so endoscopic ain't the move,
Perioperative chemo is the protocol we prove,
FLOT regimen — four cycles pre, four cycles post,
Docetaxel, oxaliplatin, fluorouracil — that's the host,
Subtotal gastrectomy, R-zero margins, that's the aim,
D2 dissection mandatory, leave no node unclaimed,
Staging laparoscopy first to rule out peritoneal spread,
CT chest-abdomen-pelvis, PET if needed overhead,
Multidisciplinary board convenes before the knife descends,
Nutrition optimised, prehabilitation, that's how planning ends
[Chorus]
D2 — stations one through twelve, memorise the map,
Perigastric, coeliac, hepatic — seal that gap,
ESD or gastrectomy — size and depth decide,
cT3N1 needs FLOT and a D2 resection guide,
Stations one to twelve, perioperative chemo in your hand,
Self-assess the staging, build your surgical command
[Verse 2]
Now define D2 for total gastrectomy, let's dissect the layers,
Stations one and two — cardia, right and left paracardial players,
Three and four — lesser curvature, greater curvature's embrace,
Five and six — suprapyloric, infrapyloric keeping pace,
Seven sits along the left gastric artery's trunk,
Eight-A, common hepatic, anterior branch — don't be drunk,
Nine's the coeliac axis, ten the splenic hilum's call,
Eleven proximal and distal along the splenic vessels, gather all,
Twelve-A, hepatoduodenal ligament closes out the tour,
Stations one through twelve — that's D2, nothing less, nothing more,
Beyond twelve you're reaching D3, oncologic debate begins,
Western trials showed D2 survivorship wins
[Chorus]
D2 — stations one through twelve, memorise the map,
Perigastric, coeliac, hepatic — seal that gap,
ESD or gastrectomy — size and depth decide,
cT3N1 needs FLOT and a D2 resection guide,
Stations one to twelve, perioperative chemo in your hand,
Self-assess the staging, build your surgical command
[Verse 3]
Two-point-five centimetres, well-differentiated, intramucosal growth,
No ulceration documented — now weigh the evidence of both,
ESD — endoscopic submucosal dissection — curative intent,
When invasion's mucosal only and the margins represent,
Lymphovascular invasion absent, size within the criteria met,
Well-diff intramucosal lesion, ESD clears the debt,
But cross the muscularis mucosae, drop into submucosa's floor,
SM2 invasion triggers gastrectomy, lymph node risk is more,
So two-point-five well-diff intramucosal — ESD's your pen,
Scrutinise the histology post-resection once again,
Curative resection confirmed — vertical and lateral margins clean,
Follow surveillance protocol, endoscopy to convene