A 75-year-old man is admitted with epigastric pain, anemia, and weight loss. On upper gastrointestinal endoscopy, a large ulcer is found in the distal antrum. The biopsy report shows adenocarcinoma of the stomach. CAT scan of the liver shows no metastasis. You would recommend:

**Core Concept**
The underlying principle being tested is the management of **gastric adenocarcinoma**, specifically considering the location and stage of the cancer. This involves understanding the role of surgical intervention in treating stomach cancer.

**Why the Correct Answer is Right**
Given the absence of liver metastasis, the patient is a candidate for curative resection, which typically involves a **subtotal gastrectomy** for distal gastric cancers. This approach aims to remove the tumor completely, along with a portion of the stomach and potentially affected lymph nodes, to achieve the best possible outcome.

**Why Each Wrong Option is Incorrect**
**Option A:** Would be incorrect if it suggested a palliative approach without considering curative resection.
**Option B:** Might be incorrect if it recommended an inappropriate surgical approach or extent of resection.
**Option D:** Could be wrong if it suggested a treatment that doesn't align with current guidelines for resectable gastric cancer.

**Clinical Pearl / High-Yield Fact**
In the management of gastric cancer, the location of the tumor (cardia vs. distal stomach) influences the surgical approach. For distal stomach cancers, a subtotal gastrectomy is often preferred, aiming for R0 resection.

**Correct Answer:** D. Subtotal gastrectomy.

✓ Correct Answer: C. Subtotal gastrectomy