Distal spread of gastric cancer is least towards duodenum may be because of anatomy or otherwise.Distal resection margin in distal gastrectomy should be atleast 5 cms.
The distal margin in D1 involvement can be obtained by carefully dissecting between the pancreas and duodenum. Aim for at least 1 cm.
Its rare for gastric cancers to cross the pylorus . Attempt to get at least 2cm margin on distal side but if course limitations anatomically
Anatomically the pylorus restricts the spread of gastric Ca to duodenum but there are many case reports in literature where spread to duodenum has been reported and that is due to rare lymphogeniac spread ( variant) so there cud still be submucosal spread to duodenum rarely under normal looking mucosa
The lymphatic drainage of stomach toward the celiac ganglion at the root of celiac trunk where it is originated from aorta
but may metastasis distally if lymph obstruction proximally
Usually one centimeter is adequate for distal margin ,and it is rarely invade the duodenum ,because of tumor pathognesis and pathological behavior of the tumor being diffuse type intestinal metaplasia
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