Surgery for stomach cancer

The goal of surgery for stomach cancer depends on the stage of your illness. Whenever possible, the surgery will aim to cure the patient (curative surgery).

Surgery is the primary procedure in curative treatment for stomach cancer. In order to minimize the risk of recurrence, we combine the surgery with other treatments like chemotherapy, or a combination treatment as part of a trial. This will increase the chance of recovery.

Curative surgery

Curative surgery for stomach cancer aims to cure you by removing the part of the stomach that has developed a tumor, and as many lymph nodes as possible from the surrounding area of the body. Depending on the location and progression of the tumor and the type of stomach cancer, we will either remove a part of the stomach (partial gastrectomy), or the entire stomach (total gastrectomy).

If stomach cancer has developed into a late stage, it can no longer be cured. If this is the case, we discuss the wishes and options for a suitable palliative treatment with the patient.

Palliative surgery

If we believe that the surgeon will not be able to remove the entire tumor and all cancer cells, we usually avoid surgery entirely. In certain cases, an operation may be suggested to alleviate gastrointestinal symptoms. Your surgeon will remove part of the stomach, or create a new passage from the stomach to the small intestine.

Surgery for stomach cancer – what to expect?

This surgery requires general anesthesia. Your anesthesiologist will attach an epidural catheter for pain management during and and after the surgery, before administering the anesthetic.

Inspection

We start all our stomach surgical procedures with a thorough inspection of the abdominal cavity. If needed, we can take tissue biopsies for rapid urease testing. Curative treatment is only an option if there are no metastases elsewhere in the body. The stomach and all related lymph nodes will be detached, as will the omentum attached to the stomach.

Partial or total gastrectomy

In case of a partial gastrectomy, we will make an incision about one third down from the top of the stomach. In case of a total gastrectomy, we will make an incision at the gastroesophageal junction, where the esophagus meets the stomach. The part below the cut will be removed, down to the second incision directly below the pyloric sphincter (at the top of the duodenum, the small intestine). Your surgeon will craft a new connection to the small intestine (called an anastomosis).

Connection

After a total gastrectomy, your surgeon will need to create a second connection for bile and pancreatic fluid drainage into a later section of the small intestine (Roux-en-Y reconstruction). After a partial gastrectomy, your surgeon can choose between a Roux-en-Y reconstruction or an extra bypass (Billroth II anastomosis). Before the surgery is completed, your surgeon will place a drain in your stomach for the wound discharge, and a feeding tube leading to your lower intestine (jejunostomy).

Effectiveness

Surgery aims to cure the illness by removing the tumor and relevant lymph nodes. Sometimes the surgery shows that the tumor has spread through the body after all. If this is the case, the surgery will be discontinued, or will have a palliative aim instead.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

Side-effects

All surgical procedures carry risks. Through a set of measures, we try to minimize these risks as much as possible.

Potential complications

Potential complications that may arise are: pneumonia, cardiovascular complications, wound infections, and gastric leaks.

Food and drink

The surgery may affect your appetite and sense of taste. It will also affect your portion sizes. Some patients experience reflux – the flow of food, drink, or bile in the wrong direction. Consuming smaller portions can alleviate these symptoms. If needed, there are several prescription drugs that can help.

You will be tube fed directly after surgery. Your dietician can help you adjust to your diet when transferring to a solid diet.