Surgery may be used to remove the cancer and part or all ofthe stomach, depending on the type and stage of stomach cancer. The surgeon will try to leave behind as much normal stomach as possible.

At this time, surgery offers the only realistic chance to cure stomach cancer. If a patient has a stage 0, I, II, or III cancer and is healthy enough, an attempt should be made to treat the cancer with surgery. Some patients with stage IV cancer that has not spread to distant sites may also benefit from surgery.

Even when the cancer is too widespread to be removed completely by surgery, patients may be helped by it because it may help prevent bleeding from the tumor or prevent the stomach from being blocked by tumor growth. This type of surgery is called palliative surgery, meaning that it relieves or prevents symptoms but it is not expected to cure the cancer.

The type of operation usually depends on what part of the stomach is involved and how much cancer is in the surrounding tissue. There are 3 kinds of surgery that may be used to treat stomach cancer:

Endoscopic mucosal resection

In this procedure, the cancer is removed through an endoscope (a long, flexible tube passed down the throat and into the stomach). This procedure is only done for some very early stage cancers, where the chance of spread to the lymph nodes is very low.

Subtotal gastrectomy

This operation is often recommended if the cancer is only in the lower part of the stomach. 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 (the duodenum). Nearby lymph nodes are also removed. The remaining section of stomach is then reattached. Eating is much easier if only part of the stomach is removed instead of the entire stomach.

Total gastrectomy

This operation is done if the cancer has spread throughout the stomach. It is also often advised if the cancer is in the upper part of the stomach, near the esophagus. It involves totally removing the stomach and nearby lymph nodes, and may include removal of the spleen and parts of the esophagus, intestines, pancreas, and other nearby organs.

If you have a total gastrectomy, the surgeon will make a new "stomach" out of intestinal tissue. Usually the end of the esophagus is attached to part of the small intestine, and some extra intestine is also attached. This can make room for food to be stored before moving down the intestinal tract, and will allow you to eat some food before getting filled up. But people who have a total gastrectomy can only eat a small amount of food at a time. Because of this, they must eat more often.

Lymph node removal

In either a subtotal or total gastrectomy, the nearby lymph nodes and some of the omentum are usually removed. The omentum is an apron-like layer of fatty tissue that covers the stomach and intestines.

Lymph node removal is a very important part of the operation. Many doctors feel that the success of the surgery is directly related to how many lymph nodes the surgeon removes. In the United States, it is recommended that a gastrectomy be accompanied by nearby lymph node removal (called a D1 lymphadenectomy) with the goal of removing at least 15 nodes. Surgeons in Japan have had very high success rates by doing a more extensive removal of the lymph nodes near the cancer (called a D2 lymphadenectomy). Surgeons in Europe and the United States have not been able to equal the results of the Japanese surgeons. It is not clear if this is because Japanese surgeons are more experienced (stomach cancer is much more common in their country), because Japanese patients have earlier stage disease (because they screen for stomach cancer) and are healthier, or if there are other factors that play a role.

In any event, it takes a skilled surgeon who is experienced in stomach cancer surgery to remove all the lymph nodes successfully. It is important that you ask your surgeon about his or her experience in operating on stomach cancer. Studies have shown that the results are better when both the surgeon and the hospital have had extensive experience in treating patients with stomach cancer.

Possible complications and side effects of surgery

Surgery for stomach cancer is difficult, and complications can occur. These can include bleeding from the surgery, blood clots, and damage to nearby organs during the operation. Rarely, the new connections made between the ends of the stomach or esophagus and small intestine may leak.

Surgical techniques have improved in recent years, so only about 1% to 2% of people die from surgery for stomach cancer. This number is higher (as high as 5% to 15%) when the operation is more extensive, such as when all the lymph nodes are removed, but is lower in the hands of highly skilled surgeons.

You may develop other side effects after you have recovered from surgery. These can include frequent heartburn, abdominal pain (particularly after eating), and vitamin deficiencies. The stomach is important in helping the body absorb some vitamins. If certain parts of the stomach are removed, doctors routinely prescribe vitamin supplements, some of which can only be injected. Changes in your diet will often be needed after a partial or total gastrectomy. The biggest change is that you will need to eat smaller, more frequent meals.

Because of these problems, it is important that you discuss with your surgeon how big an operation he or she intends to do. Some surgeons try to leave behind as much of the stomach as they can to allow patients to be able to eat more normally afterward. The tradeoff is that the cancer might be more likely to come back. The extent of the surgery should be discussed between patient and doctor before it is done.

It cannot be stressed enough that your surgeon must be highly skilled. He or she should be experienced in treating stomach cancer and able to perform the most up-to-date operations to reduce your risk of complications.

Last Medical Review: 11/03/2009
Last Revised: 11/03/2009