Access: An upper midline or left subcostal incision is best, depending on the angle of the costal margin.
The exposure and exploration are aided markedly by installation of a fixed blade retractor.
A careful, systematic exploration of the abdomen is performed to detect distant metastases (peritoneum, liver, distant nodal basins).
The splenic flexure of the colon is mobilized inferiorly; cephalad retraction of the stomach and caudad retraction of transverse colon exposes the pancreatic bed.
Vessels along the greater curvature of the stomach, including the vasa brevia, are ligated with fine silk ties and divided.
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