Surgery to remove stomach cancer
This page tells you about the types of operation used for stomach cancer. There is information about
Surgery to remove stomach cancer
The type of operation you have to remove your stomach cancer will depend on where in the stomach the cancer is. You may have part or all of your stomach removed. If your cancer is near where your stomach is joined to your gullet (oesophagus) you may need part of your gullet removed as well. These are all major operations. Find out more information about each of these operations in the full length version of this page.
If your cancer has spread to another part of your body, you are less likely to have any of these operations as they will not cure your cancer. But you may have an operation to bypass or remove part of the tumour if it is blocking your gullet (oesophagus) or stomach.
What happens if my stomach is removed?
If only part of your stomach is removed you will have to eat small amounts of food more often, at least for a while, until your system learns to cope with a smaller stomach capacity.
If your whole stomach is removed, you may eventually return to eating normally, but this will take longer. You will also have to have injections of vitamin B12 for the rest of your life to prevent anaemia and nerve problems. We have more information about diet after stomach surgery
You can view and print the quick guides for all the pages in the Treating stomach cancer section.
Any surgery for stomach cancer is a major operation and it will take some time to recover. Your doctor must be sure you are fit enough to get through an anaesthetic and long operation, and make a good recovery.
The operation you have to remove your stomach cancer will depend on where in the stomach the cancer is. If your cancer has spread to another part of your body, you are less likely to have any of these operations as they will not cure your cancer. But you may have an operation to bypass or remove part of the tumour if it is blocking your gullet (oesophagus) or stomach. There is more about this in the CancerHelp UK section on surgery to relieve symptoms of stomach cancer.
And there is information about research into new ways of doing surgery in the what's new in stomach cancer section.
If your cancer is at the lower end of the stomach (that connects with the duodenum) you may have only part of your stomach removed. This is called a partial gastrectomy. The position of the tumour in the stomach will affect how much of the stomach is removed. After the operation you will have a much smaller stomach but the valve (cardiac sphincter) between your gullet (oesophagus) and stomach will still be there. The scar from the operation will be across your abdomen.
Before partial gastrectomy
After partial gastrectomy
If your cancer is in the middle of the stomach you may need to have your whole stomach removed. This operation is called a total gastrectomy with a Roux-en-Y reconstruction. After the operation your gullet is joined directly to your small bowel. The scar from the operation will be up and down (vertical) or across your abdomen (horizontal).
Before gastrectomy
After gastrectomy
For some cancers in the upper part of the stomach or close to the area where the gullet joins the stomach (oesophagogastric junction) an extended total gastrectomy may be done. In this operation, the whole stomach is removed as well as
- Part of the omentum (the sheet of connective tissue that holds the stomach in place)
- The spleen
- Part or all of the pancreas
- Some of the lymph nodes around the main artery (aorta)
Keyhole surgery is also called ‘minimal access surgery’ or ‘laparoscopic surgery’. It means having an operation without needing a major incision (wound site). The surgeon uses an instrument that is a bit like a bendy telescope. There is an eye piece so the surgeon can see inside the body. The laparoscope also has small instruments that fit down the tube. The surgeon can manipulate these and watch what they are doing through the eyepiece. Normally, the surgeon has to use more than one entry site and you have a few small wounds, each an inch or so long. A larger cut may be necessary in some people.
It is possible for an experienced surgeon to remove the whole of your stomach, or part of it, using laparoscopic surgery. In a review of a number of trials, one advantage of laparoscopic surgery over normal ‘open’ surgery was that it led to fewer complications.
There can be drawbacks. In 1 to 3 out of 100 of these operations (1 to 3%), the surgeon has to switch to regular ‘open’ surgery during the procedure. This could be because the position or size of the tumour makes it difficult to reach, or because there is difficulty controlling bleeding. Some doctors are worried that it is difficult to remove enough lymph nodes with this type of surgery
The National Institute for Health and Clinical Excellence (NICE) have issued guidance on laparoscopic gastrectomy. They have decided that this procedure is both safe enough, and works well enough to be used as part of NHS treatment. But they stress that you should only be offered this type of surgery for cancer if it is suitable for your individual condition. And if you do have this type of surgery, it must be done by a surgeon trained in laparoscopic techniques and experienced in using them.
If you want to find out if this type of surgery is suitable for you, talk to your surgeon. You may need a referral to a specialist surgeon with particular experience in laparoscopic surgery.
If your cancer is near where your stomach is joined to your gullet (oesophagus) you may need part of your gullet removed as well. This is called oesophagogastrectomy. The top portion of your gullet will be joined to your small bowel.
Sometimes, with this operation, the furthest third of your stomach is kept and made into a tube. In this case, your remaining oesophagus will be joined onto this remaining part of your stomach. Because your gullet has to be operated on, you will have a bigger scar than for the other stomach operations. Your surgeon can remove the stomach and oesophagus through an abdominal wound or through a chest wound. So, you may have a scar across part of your chest, along one of the ribs. Or you may have a wound down the middle of your tummy (abdomen).
Before surgery
After surgery
During your operation you will have all of the lymph nodes close to your stomach tumour removed. This is because they may contain cancer cells that have broken away from the main cancer. Taking them out reduces the risk of your cancer coming back in the future. This is called a D1 lymph node dissection.
Taking more lymph nodes out from further away is called a D2 dissection. This includes the nodes along the main blood vessels supplying the stomach. This takes longer and is a bigger operation but can further reduce the chance of the cancer coming back. Your surgeon will consider doing a D2 resection if
- You are very fit
- You have a long life expectancy if your cancer doesn't come back (in other words, you don't have any other life threatening illnesses, such as heart disease)
- It is possible to remove all of your stomach cancer.
If only part of your stomach is removed you will have to eat small amounts of food more often, at least for a while, until your system learns to cope with a smaller stomach capacity. The stomach that is left will gradually stretch so that you can eat more at a time.
If your whole stomach is removed, you may eventually be able to eat normally again, but this will take longer. You will also have to have injections of vitamin B12 for the rest of your life to prevent anaemia and nerve problems. There is more about diet after stomach surgery in the of CancerHelp UK.
For a while before or after stomach surgery you may need to have liquid food into a vein or directly into your bowel. There is information about these types of nutritional support in our section on coping physically with cancer. You will have information about these from your dietician and clinical nurse specialist.
It is common to have diarrhoea for some months after stomach surgery. This can be very upsetting and you may feel weak for a time. There is more about coping with diarrhoea in the living with stomach cancer section.
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