Stomach Cancer: Surgery

Stomach cancer may be treated with surgery. Different kinds of surgery may be done. Which type you have depends on the type of cancer, where it is, how much it has spread, and other factors. A gastrectomy is the most common type of surgery for stomach cancer. Less common is an endoscopic resection.

Is surgery right for you?

Your health care provider may advise surgery for you if it may help cure the cancer. At this time, surgery is the only way that stomach cancer may be cured. Surgery to cure cancer is often done with chemotherapy and radiation therapy. Surgery is an option for you if:

  • Your cancer is resectable. This means your surgeon will be able to remove it. 

  • The cancer has not spread to parts of the body far away from the stomach.

  • You are healthy enough for the surgery.

In some cases, surgery may not be able to cure the cancer. In this case, your health care provider may advise surgery to ease or prevent some symptoms of cancer. This type of surgery is not done to cure the cancer. It is known as palliative surgery.

Risks of surgery for stomach cancer

All surgery has risks. The risks of surgery for stomach cancer include:

  • Excess bleeding

  • Infection

  • Blood clots

  • Damage to nearby organs or tissue

  • Leaking of fluids where organs are reattached during surgery (rare)

Side effects of surgery for stomach cancer

There are possible side effects when all or part of the stomach is removed. They can include:

  • Heartburn

  • Pain in the belly (abdomen)

  • Diarrhea

Over time, the side effects may lessen. Talk with your health care provider about any side effects you have. He or she can help you manage them.

Endoscopic resection

One type of surgery for stomach cancer is endoscopic resection. A tool called an endoscope is passed down the throat to the stomach to remove the cancer. Some very early stage stomach cancer can be treated with this surgery. But it is rarely done in the U.S. This is because stomach cancer is not often found at a very early stage. Some cancer centers in the U.S. offer this procedure.

Subtotal or partial gastrectomy

A subtotal or partial gastrectomy means that part of the stomach is removed. It is done for people with cancer in the lower part of the stomach. It may also be done for cancer only in the upper part of the stomach. 

For this surgery, the surgeon takes out the part of your stomach that has cancer. He or she then attaches the part of the stomach that is left to the esophagus and small intestine. He or she may also remove:

  • Part of the tube from your throat to your stomach (esophagus)

  • Part of your small intestine

  • Nearby lymph nodes

  • Part of other tissues and organs near the stomach

Total gastrectomy

A total gastrectomy means that all of the stomach is removed. Some nearby organs are removed as well. It is done for people with cancer throughout the stomach. It may also be done for cancer in the upper part of the stomach.

The surgeon removes:

  • Your entire stomach

  • Nearby lymph nodes

  • The fatty covering of the stomach and other organs (omentum)

He or she may also remove part of your:

  • Esophagus

  • Small intestine

  • Pancreas or other nearby organs

The surgeon attaches the end of your esophagus to your small intestine. Food can still move through your intestines. But because you no longer have a stomach and parts of other organs, you will have to eat small amounts more often.

After this surgery, it may be hard to eat enough. Your surgeon may place a feeding tube through your abdomen into your small intestine. Special high-nutrient liquids are given through the tube.

Palliative surgery

Some stomach cancers cannot be cut out. The goal of surgery is then to lessen the effects of the cancer, not to try to cure it. In these cases, surgery may be done to prevent or lessen symptoms and complications from the cancer.

Palliative surgery can include:

  • Subtotal or partial gastrectomy. The part of the stomach with the cancer is removed. This can help to ease symptoms. 

  • Gastric bypass (gastrojejunostomy). The upper part of the stomach is attached to part of the small intestine. It is done to ease symptoms from cancer in the lower part of the stomach.

  • Endoscopic procedures. An endoscope is passed down the throat through the esophagus and into the stomach. A special tool may be used to destroy some of the cancer. Or a short, hollow tube (stent) may be used open up blockages caused by the cancer.

  • Feeding tube placement. The feeding tube may be placed directly into the stomach or small intestine. Special high-nutrient feedings are given through the tube. This helps a person with cancer get enough fluids and nutrition.

Getting ready for your surgery

Before you have surgery, you will talk with your surgeon. Your surgeon may be a general surgeon, a gastrointestinal surgeon, or a surgical oncologist. You will talk with your surgeon about:

  • How much of your stomach and other organs or tissues are likely to be removed. Some surgeons try to leave behind as much of the stomach as they can. This may allow people to eat more normally after surgery. But the cancer may be more likely to return.

  • His or her experience in surgery for stomach cancer. The results may be better when both the surgeon and the hospital have more experience treating patients with stomach cancer. 

  • Any questions or concerns you have.

  • The risks and possible complications of the surgery.

After you have talked about all the details of the surgery, you will sign a consent form. This gives the surgeon permission to perform the surgery.

You will also talk with an anesthesiologist. This is the health care provider who will give you the general anesthesia. General anesthesia is medication that prevents pain and makes you sleep during surgery. He or she also monitors you during surgery to keep you safe. He or she will ask about your medical history and your medications.

What to expect during surgery

On the day of surgery, you will be taken into the operating room. Your health care team will include the anesthesiologist, the surgeon, and several nurses. 

During a typical surgery:

  • You will be moved onto the operating table. 

  • You may need to wear special stockings on your legs. These are to help prevent blood clots. 

  • You will have electrocardiogram (EKG) electrodes put on your chest. These are to keep track of your heart rate. You will also have a blood pressure cuff on your arm.

  • You will be given anesthesia through an IV tube in your hand or arm.

  • When you are asleep, the surgeon will do the surgery.

What to expect after surgery

You will wake up in a recovery room. You will be watched closely by health care providers. You will be given medicine to treat pain.

You may be in the hospital for several days. You may not be able to return to work or other activities for several weeks.  

After any major surgery you may:

  • Have post-operative pain. The pain can be effectively managed with medicine.

  • Feel tired or weak. The amount of time it takes to recover from surgery is different for each person.

  • Have constipation. This can be caused by the pain medicine. It can also be caused by not moving much, and from not drinking or eating much. Talk with your health care provider or nurse about how to keep your bowels moving.

After this surgery you may:

  • Be unable to eat or drink for a few days or more after surgery, to give your stomach time to heal

  • Learn how to care for your feeding tube, if one was placed at the time of surgery

  • Need to make changes in your diet and eat smaller meals more often during the day

  • Need to take vitamins

  • Have chemotherapy or radiation therapy

You will have follow-up appointments with your surgeon and other health care providers. You may meet with a dietitian, who can help you plan your diet. Make sure to keep your appointments. If you have any problems or concerns, contact your health care team.