Surgery for stomach cancer
Surgery is often part of the treatment for stomach cancer if it can be done. Depending on the type and stage of your cancer, surgery might be used to remove the cancer and part or all of your stomach. The surgeon will try to leave behind as much normal stomach as possible. Sometimes other organs will need to be removed as well.
At this time, surgery (often along with other treatments) offers the only real chance to cure stomach cancer. If you have stage 0, I, II, or III cancer, and if you are healthy enough, your doctor will likely try to treat your cancer with surgery.
Even if the cancer is too widespread to be completely removed, an operation could help prevent bleeding from the tumor or keep the stomach from being blocked. This type of surgery is known as palliative surgery, meaning that it relieves or prevents symptoms but is not done to cure the cancer.
The 3 main types of surgery for stomach cancer
- Endoscopic mucosal resection: Resection refers to cutting out a tumor or part of an organ. In this operation, the cancer is removed through an endoscope (a long, flexible tube passed down the throat and into the stomach). This can be done only for some very early cancers where the chance of spread is very low.
- Subtotal (partial) gastrectomy: This approach is often used if the cancer is only in the lower part of the stomach close to the intestines. It is also sometimes used for cancers that are only in the upper part of the stomach. Only part of the stomach is removed, sometimes along with part of the esophagus or the first part of the small intestine. Nearby lymph nodes are also removed, sometimes along with other nearby organs. Eating is much easier after surgery when only part of the stomach removed.
- Total gastrectomy: This method is used if the cancer has spread throughout the stomach. It is also often used if the cancer is in the upper part of the stomach. The surgeon removes all of the stomach. The nearby lymph nodes are removed, and sometimes also the spleen and parts of the esophagus, intestines, pancreas, and other nearby organs. The end of the esophagus is then attached to part of the small intestine. People who have had a total gastrectomy can only eat a small amount of food at a time. Because of this, they must eat more often.
Most subtotal and total gastrectomies are done through a large incision (cut) in the skin of the abdomen. Some centers are now looking at the use of laparoscopic surgery for these operations, in which the surgeon operates through several smaller cuts in the abdomen (see “What’s new in stomach cancer research?”).
Placement of a feeding tube
Some patients have trouble taking in enough food after surgery for stomach cancer. Further treatment like chemotherapy with radiation can make this problem worse. To help with this, a tube can be placed into the intestine at the time of gastrectomy. The end of this tube, called a J tube, stays outside of the skin on the abdomen. This allows liquid nutrition to be put straight into the intestine and can help prevent and treat malnutrition.
Taking out lymph nodes
In either a subtotal or total gastrectomy, the lymph nodes and some of the fatty tissue (omentum) around the stomach are removed.
Many doctors feel that the success of the surgery is linked to how many lymph nodes the surgeon removes. In the United States the goal is often to remove at least 15 nodes. But it takes a skilled surgeon with experience in operating on stomach cancer to do this safely. Studies have shown that the results are better when both the surgeon and the hospital have treated a lot of patients with stomach cancer. It is important to ask your surgeon about his or her experience in operating on stomach cancer.
Palliative surgery for cancer that cannot be removed
For people with stomach cancer that cannot be removed (unresectable), surgery can often still be used to help control the cancer or to help prevent or relieve symptoms or problems.
Subtotal gastrectomy: For some people who are healthy enough for surgery, taking out the part of the stomach with the tumor can help treat problems such as bleeding, pain, or blockage in the stomach, even if it does not cure the cancer.
Gastric bypass (gastrojejunostomy): Tumors in the lower part of the stomach may grow large enough to block food from leaving the stomach. For people healthy enough for surgery, one option to help prevent or treat this is to bypass the lower part of the stomach. This is done by linking part of the small intestine (called the jejunum) to the upper part of the stomach, which allows food to leave the stomach through the new connection.
Endoscopic tumor ablation: In some cases, such as in people who are not healthy enough for surgery, an endoscope (a long, flexible tube passed down the throat) can be used to guide a laser beam to destroy parts of the tumor. This can be done to stop bleeding or help relieve a blockage without surgery.
Stent placement: Another option to keep a tumor from blocking the opening at the beginning or end of the stomach is to use an endoscope to place a stent (a hollow metal tube) in the opening. This helps keep it open and allows food to pass through it.
Feeding tube placement: Some people with stomach cancer are not able to eat or drink enough to get enough nutrition. A minor operation can be done to place a feeding tube through the skin of the abdomen and into the distal part of the stomach (known as a G tube) or into the small intestine (known as a J tube). Liquid nutrition can then be put directly into the tube.
Possible problems and side effects of surgery
Surgery for stomach cancer is complex and can lead to problems. These could include bleeding from the surgery, blood clots, and damage to the nearby organs. Rarely, the new connections between the ends of the stomach and esophagus or small intestine may not hold together and can leak. These problems, which could be fatal, were more common in the past. Today, only about 1% to 2% of people die after this surgery. This number can be higher when all the lymph nodes are removed, but it is lower in the hands of highly skilled surgeons.
Other side effects may start after you have recovered from surgery. These could include nausea, heartburn, abdominal pain, and diarrhea (especially after eating), as well as shortages of some vitamins. The stomach is important in helping the body take in certain vitamins. If some parts of the stomach are removed, the doctor will prescribe vitamin supplements. Some of these can only be taken only as shots (injections). After stomach surgery, most people will need to change their diets, eating smaller meals more often.
It is very important that you talk to your doctor before surgery about what you are going to have. Some surgeons try to leave behind as much of the stomach as they can so that patients will have fewer problems later. But the tradeoff is that the cancer might be more likely to come back. Again, it’s important that your surgeon be very skilled, have a lot of experience, and be able to do the most up-to-date operations.
To learn more about surgery for cancer, see our document Understanding Cancer Surgery: A Guide for Patients and Families.
Last Medical Review: 03/18/2013
Last Revised: 04/22/2014