What Happens During Surgery for Stomach Cancer

Surgery

The type of surgery you have depends on the exact location of the cancer and whether it has spread.

Preparing for surgery

Before you go for surgery, you will meet with your surgeon to talk about the procedure. A surgeon who operates on stomach cancer may be a general surgeon, a gastrointestinal surgeon, or a surgical oncologist. When you meet your surgeon, you can ask any questions and discuss any concerns you have. This is also a good time to review the possible side effects of the surgery and to talk about the risks. You may ask if the surgery will leave scars and what those scars will look like. You may also want to ask when you can expect to return to your normal activities.

You may have a meeting with an anesthesiologist or nurse anesthetist. The anesthesiologist is responsible for keeping you sedated, pain-free, and safe during the surgery. They will ask about your health history and your medications.

After you have discussed all the details with the surgical team, you will sign a consent form that says that you understand the risks involved and that the doctor can perform the surgery. The hospital admissions department is likely to have other paperwork you’ll need to complete, either before or on the day of your surgery.

On the day of the surgery

On the day of your surgery, you should arrive at the hospital admission area at the time your doctor indicated. In the preoperative area, you will be asked to undress and put on a hospital gown. During this time, members of the surgical team may ask you again about your past medical history, medications, and drug allergies. Try not to get frustrated by the repetition. These questions are repeated to help prevent mistakes. They may also answer any other questions you might have about the procedure.

When it is time for your surgery, you will be taken into the operating room. Many people are there, including the anesthesiologist, the surgeon, and several nurses. To ensure sterility, everyone will be wearing a head covering and a facemask. You may see X-ray images on a viewing box.

Once in the room, you will be moved onto the operating table. The surgery team may place an intravenous line called an IV into your arm if it has not been done. The IV is used to give you anesthetic to make you sleep and remain pain-free during the surgery. You may also receive other medications and fluids through the IV.

You may need to wear special stockings on your legs to help prevent blood clots. You will have EKG wires attached to your chest to keep track of your heart rate, and a blood pressure cuff wrapped around your arm. When all the preparation is complete, you will receive the anesthetic through the IV to put you to sleep.

What the surgeon removes and where he or she makes your incisions depend on the type of surgery you have. In an attempt to cure stomach cancer, surgeons usually remove the following:

  • Part or all of your stomach.

  • Nearby lymph nodes, which are bean-sized collections of tissue that are part of your immune system. They are important in fighting infections and cancers.

  • Some of the omentum, which is an area of fatty tissue near the stomach and intestines.

Many surgeons believe that removing all the lymph nodes near the stomach improves the chance of a cure. If cancer has reached other organs, such as the spleen, the surgeon may remove those organs as well.

There are two main types of surgery for removing stomach cancer: subtotal or partial gastrectomy and total gastrectomy. 

Subtotal or partial gastrectomy

This type of surgery works well for people whose cancer involves the lower part of the stomach. Also called the distal part of the stomach, this is the part near your small intestine. For this procedure, the surgeon removes the part of your stomach that contains cancer. The surgeon may also remove these other organs that are near your stomach:

  • The end of the pancreas

  • The spleen, which is a blood-filtering organ

  • Nearby lymph nodes

  • Parts of other tissues and organs near the tumor, such as the small intestines.

To perform this surgery, the surgeon makes an up-and-down cut in the middle of your abdomen.

Total gastrectomy

This surgery is done for people who have cancer in the middle or upper part of the stomach. For this surgery, the surgeon makes an up-and-down cut (incision) in the middle of your abdomen. The surgeon removes these organs:

  • Your entire stomach

  • The bottom part of your esophagus

  • The first part of your small intestine called the duodenum

  • Nearby lymph nodes

  • Possibly other organs near the tumor

The surgeon reconnects your esophagus to the second part of your small intestine called the jejunum. This new connection allows you to continue to eat and digest food, although you will only be able to eat a small amount of food at a time. The surgeon may also place a special tube called a jejunostomy feeding tube (J-tube) through your abdominal skin and into the second part of your small intestine. This tube allows you to receive special liquid feedings while you are not able to take any fluids by mouth.