Profesionales médicos

Dec. 09, 2025

Innovation often moves quickly in oncology. Five years ago, patients with stomach cancer had limited options.

"From a surgical standpoint, open gastrectomy was the main treatment," says Travis E. Grotz, M.D., M.S., a surgical oncologist at Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota. "Patients spent about a week in the hospital and required a feeding tube. Rapid gastric emptying and diarrhea after eating often limited quality of life after surgery."

Today, novel treatment strategies target stomach cancer from many angles. Dr. Grotz describes six advances that are expanding care for patients at all stages of the disease and paving the way for future breakthroughs.

1. Minimally invasive stomach cancer surgery

Minimally invasive surgery for stomach cancer is less common in the U.S. than in other countries, but its use is expanding. Randomized trials have demonstrated the safety of laparoscopic versus open surgery with good oncological outcomes. Robotic platforms take minimally invasive surgery one step further.

Robotic instrumentation offers multiquadrant access, 3D and magnified visualization, and 270-degree articulation. These improvements make it possible to use robotic surgery for the most complicated stomach cancer surgeries, including full and partial gastrectomies, reconstruction, lymph node removal, and metastatic disease.

Robotic surgery significantly improves recovery outcomes with shorter hospital stays — typically three or four days — and fewer complications, such as being able to avoid routine use of feeding tubes. Patients also experience a faster return to typical eating and daily activities.

2. J-pouch reconstruction following gastrectomy

Mayo Clinic surgeons combine the benefits of minimally invasive gastrectomy and J-pouch construction for patients. A J-pouch is a small reservoir created by folding the intestine after the stomach is removed. The pouch acts like a stomach, holding food and preventing it from passing through too quickly. Pouch size is a crucial factor in reconstruction. Studies have shown that large pouches don't empty well. The ideal emptying time is about 90 minutes.

"Research has demonstrated significant improvements in quality of life with J-pouch reconstruction compared with traditional gastrectomy," explains Dr. Grotz. "Patients can eat larger meals and lose less weight. They're also less likely to experience dumping syndrome, which causes nausea, hot flashes and diarrhea after eating."

3. Proximal gastrectomy with double tract reconstruction

Treatment for tumors in the upper part of the stomach has gone through several phases. The traditional treatment is total gastrectomy. Decades ago, surgeons introduced proximal gastrectomy to spare the lower part of the stomach with good oncological outcomes. However, patients experienced severe reflux, and the procedure fell out of use.

More recently, a modified approach to proximal gastrectomy has been developed that includes double tract reconstruction. In this procedure, the surgeon connects the esophagus to the small intestine and creates a second tract with the lower stomach and duodenum. Together, the two pathways allow for better digestion and nutrient absorption.

Dr. Grotz observed Japanese surgeons performing the procedure and adapted it for the larger tumors that are more commonly seen in the U.S. He recently co-authored a study published in a 2025 issue of Cancers that examined the use of modified proximal gastrectomy. "It was a small study, but the results were promising," he says. "We achieved complete resection in all patients and observed no recurrence at 18 months. Other outcomes, including weight loss and hemoglobin levels, also were favorable."

4. Immunotherapy with, and possibly in place of, surgery

Immunotherapy is transforming stomach cancer care. The current standard treatment for locally advanced stomach cancers is neoadjuvant chemotherapy and immunotherapy, followed by surgery and adjuvant chemotherapy and immunotherapy. When possible, medical oncologists administer all chemotherapy before surgery to avoid adjuvant therapy, which causes side effects while patients are recovering from surgery.

"We are seeing remarkable outcomes with the combination of chemotherapy and immunotherapy," says Dr. Grotz. Articles published in 2023 in Annals of Surgical Oncology and in 2025 in Surgical Oncology Insight reported that up to 20% of patients have a complete response to neoadjuvant therapy. The complete response rates were even higher in a subset of patients with microsatellite instability-high tumors. Because of these results, Mayo Clinic surgeons are evaluating organ preservation for those patients.

5. Bidirectional treatment for metastatic gastric cancer

When stomach cancer metastasizes, it most often spreads to the peritoneum. In the past, the prognosis for these patients was poor. A bidirectional strategy of systemic and intraperitoneal therapies is now offering hope for prolonged survival.

Care includes neoadjuvant chemotherapy and immunotherapy followed by laparoscopic delivery of hyperthermic intraperitoneal chemotherapy (HIPEC). At the same time, the surgeon may remove the stomach, lymph nodes and other tissues.

Bidirectional treatment is complex and requires a higher-than-usual level of coordination and expertise. Because of that, it's not widely available. But at Mayo Clinic, doctors have seen remarkable outcomes with this therapy. "We see many patients with stage 4 stomach cancer, and we're often able to give them options," says Dr. Grotz.

Intraperitoneal therapy also is an active area of study at Mayo Clinic. Researchers are investigating other agents, such as immunotherapy, and other methods of delivery. They are also looking at whether intraperitoneal therapy can be used prophylactically to prevent recurrence.

6. Endoscopy with robotic sentinel lymph node mapping for early gastric cancer

Finding stomach cancer early is rare in the U.S. When it does happen, some tumors have already invaded deeper layers and are at risk of lymph node metastasis. Surgical oncologists at Mayo Clinic work with endoscopists to offer an alternative to gastrectomy for these patients.

The endoscopist removes the tumor while the surgeon maps the sentinel lymph nodes robotically. The camera on the robot allows the surgeon to see the green contrast and sample the lymph node to determine whether the cancer has spread. If the lymph nodes are negative, a gastrectomy is not needed.

Ensuring effective follow-up care after surgery

Many patients with stomach cancer travel to Mayo Clinic for care, often from very long distances. Those who require gastrectomy go home with an iPad and equipment to monitor their weight and vital signs remotely. At six weeks postsurgery, the surgeon sees them in person to assess recovery and begin discussing long-term issues, such as:

• Cancer surveillance.
• Bone health.
• Gallstone risk.
• Gastrointestinal health.
• Nutrition.

Patients can choose to receive ongoing care from the Mayo Clinic team, in person or remotely. For patients who want to transition back to their local doctors, surgeons provide detailed recommendations and remote consultations. "Our goal is to ensure every patient gets the longitudinal care they need to be as healthy as possible," says Dr. Grotz.

For more information

Siegler E, et al. Modified proximal gastrectomy and D2 lymphadenectomy is an oncologically sound operation for locally advanced proximal and GEJ adenocarcinoma. Cancers. 2025;17:2455.

Buckarma E, et al. Cytoreduction and hyperthermic intraperitoneal paclitaxel and cisplatin for gastric cancer with peritoneal metastasis. Annals of Surgical Oncology. 2023;31:622.

Buckarma E, et al. Total neoadjuvant therapy (TNT) improves completion rates of intended therapy and oncologic outcomes in locally advanced gastric cancer. Surgical Oncology Insight. 2025;2:100173.

Tedesco L. Minneapolis baker, 'Cake Wars' winner, defeats 'incurable' stomach cancer. Mayo Clinic.

Refer a patient to Mayo Clinic.