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Surgery is the most common treatment for stomach cancer. Surgeons may remove tumors when the cancer is found on the surface of the stomach’s inner lining but has not spread to any lymph nodes or other organs.
When surgery is required for stomach cancer, the goal is to remove the entire tumor as well as a good margin of healthy stomach tissue around the tumor.
Surgeons also remove all of the lymph nodes around that part of the stomach to look for evidence that the cancer has spread. Most stomach cancers spread through the lymph nodes first and then to other organs. This is an important element in determining the severity of the cancer.
Partial Gastrectomy
In a partial gastrectomy, surgeons remove the part of the stomach where a tumor is located. Sometimes they also remove a portion of the esophagus or the first part of the small intestine, called the duodenum. The remaining section of stomach is then reattached to the esophagus or small intestine. Doctors may also remove some of the omentum—a layer of fatty tissue that covers the stomach and intestines—along with nearby lymph nodes to see if the cancer has spread.
If a stomach tumor is growing into nearby organs such as the spleen, liver, or pancreas, surgeons may need to remove the parts of these organs where the tumor is attached. By doing so, it may allow our doctors to remove the entire tumor, which improves chances for a cure.
Partial gastrectomy is often recommended if the cancer is located only in the lower part of the stomach, although it can also be used to remove cancers in the upper part of the stomach.
Total Gastrectomy
If cancer has spread throughout the stomach—or if it is located in the upper part of the stomach, near the esophagus—a doctor may perform a total gastrectomy. During this procedure, the surgeon removes the entire stomach, nearby lymph nodes, and omentum. He or she may also remove the spleen and parts of the esophagus, intestines, pancreas, or other nearby organs.
The surgeon then attaches the end of the esophagus to part of the small intestine, allowing food to travel through the intestinal tract.
After surgery, you are given intravenous (IV) fluids through a vein to maintain your nutrition and hydration. You are slowly reintroduced to liquids and then regular food over a few days as the newly constructed intestinal tract heals.
It’s helpful to eat smaller meals more frequently, especially at first. The doctor may order X-rays before you eat or drink anything after surgery to make sure there are no leaks in the organs that have been sewn together.
Since partial and total gastrectomy involve shrinking or removing the stomach, eating habits often must change. Side effects from these procedures include nausea, heartburn, abdominal pain, and diarrhea, particularly after eating. These may occur because food enters the intestines too quickly after eating when part or all of the stomach has been removed.
The effects often subside over time, but they can persist for a few months in some people. A doctor may prescribe medications to counteract the symptoms.
Surgical Techniques
Surgeons use different techniques to perform stomach cancer surgery. The method a surgeon chooses depends on the size of the tumor and if it has spread to other parts of the body.
Laparoscopic Surgery
During laparoscopic surgery, a doctor makes several small incisions in the abdomen. Through one incision, he or she places a laparoscope, a lighted tube with a tiny camera. Through the remaining incisions, the doctor places small surgical tools to perform the total gastrectomy. Laparoscopic surgery can shorten recovery time and produce less scarring than open surgery.
Open Surgery
For open surgery, doctors make a large incision in the abdomen. This procedure may be necessary if the abdomen contains scar tissue from a previous procedure, which makes creating a small incision challenging. The typical hospital stay after open surgery is five to seven days to allow you to heal and regain intestinal function.
