Stomach cancer surgery

Panorama general

Surgery is the most common treatment for stomach cancer, also called gastric cancer. It is sometimes combined with other treatments, such as chemotherapy, radiation therapy, targeted therapy or immunotherapy. Your care team recommends a treatment plan based on where the cancer is and how much it has grown.

Some very early stomach cancers can be removed with an endoscope. An endoscope is a thin, flexible tube that goes through the mouth into the stomach. If the cancer has grown more, surgery may be needed to remove part or all of the stomach. Nearby lymph nodes also may be removed.

Learning that you may have stomach cancer can be hard. Your care team can explain your treatment choices and how surgery may fit into your treatment plan.

Types

The type of surgery depends on factors such as where the tumor is and how deeply it has grown. It also depends on whether nearby lymph nodes may contain cancer and whether part of the stomach can be kept while still removing the cancer completely.

• Endoscopic resection. For some cancers limited to the innermost layers of the stomach, a specialist may remove the cancer during endoscopy. Endoscopic mucosal resection (EMR) uses a snare to remove tissue. Endoscopic submucosal dissection (ESD) uses special cutting tools and can remove larger areas in one piece.
• Partial or subtotal gastrectomy. This surgery removes part of the stomach. A distal subtotal gastrectomy removes the lower part of the stomach. It can be used for cancers in that area when the surgeon can remove the cancer with clear microscopic margins, meaning no cancer cells are found at the edges of the tissue removed.
• Total gastrectomy. This surgery removes the entire stomach. Your surgeon may recommend it for cancers that involve a large part of the stomach, are in certain parts of the upper stomach or are diffuse. Diffuse means the cancer involves the stomach more broadly.

If you have a gastrectomy, the surgeon also may remove nearby lymph nodes to test for cancer. Removing lymph nodes is called lymphadenectomy. It helps show whether the cancer has spread and is an important part of surgery intended to cure stomach cancer.

A D1 lymphadenectomy removes nodes next to the stomach. A D2 lymphadenectomy removes those nodes plus nodes along major nearby blood vessels. Care teams commonly recommend D2 lymphadenectomy for stomach cancer that has grown into nearby tissues or lymph nodes but has not spread to distant parts of the body. Surgeons with experience in the procedure usually do this type of surgery.

Surgical approaches

Surgery may be open or minimally invasive. In open surgery, the surgeon operates through the stomach area, called the abdomen. Minimally invasive surgery may be laparoscopic or robotic. Minimally invasive approaches use smaller incisions. Studies have found similar cancer outcomes with minimally invasive and open gastrectomy. Minimally invasive procedures may involve less blood loss but can take longer to perform.

Por qué se hace

Surgery for stomach cancer can have different goals. Depending on the cancer, surgery may:

• Remove cancer. When stomach cancer can be removed, surgery is a main part of treatment because it removes the tumor. Surgery may remove part or all of the stomach.
• Remove nearby lymph nodes. Lymph nodes are removed and tested for signs of cancer. This is an important part of surgery intended to cure stomach cancer.
• Treat some very early cancers. For some very early cancers that have a low chance of spreading to lymph nodes, endoscopic resection may remove the cancer without removing the stomach. If the cancer has features linked to a higher risk of lymph node spread, surgery to remove part or all of the stomach typically is favored because endoscopic resection does not remove or treat nearby lymph nodes.
• Ease symptoms. When stomach cancer cannot be removed with the goal of curing it, surgery sometimes can ease symptoms. For example, your care team may consider an operation for ongoing bleeding or a blockage that prevents food from passing through the stomach.

For some cancers that have grown into the stomach wall or nearby lymph nodes, chemotherapy may be given before surgery. Chemotherapy also may be advised after surgery based on the stage and other findings.

Surgery can remove all cancer that your surgeon can find at the time of the operation. But surgery cannot guarantee that stomach cancer will not return. The chance of the cancer returning depends in part on the extent of the cancer. Cancers that are more advanced have a higher chance of coming back after treatment.

Riesgos

Stomach cancer surgery can cause complications. Some may last a short time, while others may last a long time. The risks of surgery depend on the operation, your health and other parts of the treatment plan.

Possible risks include:

• A leak in the digestive tract. This is called an anastomotic leak. It can lead to infection or a collection of fluid in the abdomen You may need another procedure or operation for treatment.
• Bleeding. Bleeding may happen inside the abdomen or digestive tract. Sometimes another procedure or operation is needed to treat it.
• Infection or a collection of fluid in the abdomen. These can happen after gastrectomy.
• Lung complications. Pneumonia and other breathing complications can occur after gastrectomy. They are among the more common serious complications reported after these operations.
• Changes in how food moves through the digestive tract. These can include a temporary slowing or stopping of the intestines, delayed stomach emptying after partial gastrectomy, or dumping syndrome. Dumping syndrome happens when food moves too quickly into the small intestine.
• Nutrition and vitamin deficiencies. Removing part or all of the stomach can affect nutrition and make it harder for your body to get enough nutrients. After stomach surgery, some people may have low levels of vitamin B-12, vitamin D or calcium. Your care team may check your nutrition over time.

Cómo prepararte

Tests before surgery help your healthcare team learn where the cancer is and how far it may have spread. These tests may include endoscopy with a biopsy, endoscopic ultrasound or a CT scan. A biopsy is a procedure that removes a tissue sample for testing. In some situations, you may have a positron emission tomography (PET) scan or minimally invasive surgery to look inside the abdomen.

Your care team checks whether you are ready for an operation. Nutrition is an important part of preparing for stomach cancer surgery. Your healthcare team may check your nutrition, strength and other health conditions, especially if cancer or difficulty eating has caused unintended weight loss or muscle loss. If you aren't getting the nutrition you need, your care team may recommend nutrition support before surgery.

Your care team gives you instructions about eating, drinking and medicines before surgery.

If you smoke, your care team advises stopping before surgery. Your care team also may recommend exercise or rehabilitation. Rehabilitation is a program that helps build your strength and fitness before surgery and helps with recovery. If you need help stopping smoking or preparing for surgery, ask your care team for support.

Qué esperar

Before surgery, your care team gives you information and support to help you prepare and recover. This may include nutrition guidance and pain management options. It may include goals for getting out of bed, eating and drinking after surgery.

The length of the procedure depends on the type of surgery and how your surgeon does it. Your surgeon tells you how long your procedure is expected to take. If you have surgery to remove part or all of your stomach, you usually stay in the hospital for several days.

Before the procedure

Surgery for stomach cancer is done in a hospital under general anesthesia. This means you are asleep and do not feel the surgery.

Before surgery, members of your cancer care team explain what they plan to do. They tell you how much of your stomach may need to be removed. They tell you whether nearby lymph nodes may need to be removed. The exact surgery depends on where the cancer is and whether it can be removed with clear margins, meaning no cancer cells are found at the edges of the tissue removed.

During the procedure

What happens during the procedure depends on the type of surgery you have.

For some very early stomach cancers, your doctor may pass an endoscope through your mouth into your stomach and remove the cancer from the stomach lining. An endoscope is a thin, flexible tube with a light, camera and small tools. This procedure does not require an incision in the abdomen.

If you have a gastrectomy, the surgeon removes part or all of your stomach and nearby lymph nodes. The surgeon then reconnects your digestive tract so food can continue to move through it. How this is done depends on how much of your stomach is removed.

After the procedure

After stomach surgery, you receive medicine and other treatments to help manage pain while limiting opioid medicines when possible. Good pain control can make it easier to take deep breaths and start moving after surgery.

• After endoscopic resection. If the cancer is removed through an endoscope, recovery is generally shorter than after surgery through the abdomen.
• After partial or total gastrectomy. If part or all of your stomach is removed, your care team gives you medicine to control pain and helps you start walking soon after surgery. You also may use a breathing device to help you take deep breaths. These steps are part of your recovery.

Before you go home, your care team makes sure you can eat and drink and move around safely. Your care team helps you manage your pain with medicines you take by mouth. Your care team also checks that your digestive system is working.

Recovery continues at home. Your care team tells you when you can increase activity and return to work or other daily activities. Follow-up visits also are important to check your recovery, nutrition and cancer treatment needs.

Resultados

After stomach cancer is removed, a pathologist examines the tissue. A pathologist is a doctor who checks tissue and cells under a microscope.

The pathology report describes features such as how deeply the cancer grew and whether cancer cells are found at the edges of the removed tissue.

The report also may include information about any lymph nodes that were removed. These findings help determine the stage, which describes the extent of the cancer based on the tissue that was removed.

The results also may include information about the surgical margin. When the cancer is removed, some healthy tissue that surrounds it also is removed. This healthy tissue is called the margin. The pathologist tests the margin for signs of cancer.

• R0 means no cancer is found in the margin.
• R1 means cancer is found in the margin. The cancer in the margin can be seen only with a microscope.
• R2 means cancer is found in the margin. The cancer in the margin can be seen without a microscope.

If no cancer is found in the margin, it's likely that all of the cancer was removed. If cancer is found in the margin, it may mean that not all of the cancer was removed.

The results from surgery help your care team decide whether you need more treatment, such as chemotherapy, radiation therapy, another surgery or some combination of these.

Even when no tumor remains after surgery, stomach cancer can come back. The chance of that happening depends in part on the stage of the cancer. Recurrence is more likely with more advanced cancer.

Coping and support

Learning that you have stomach cancer can be hard. Tell your healthcare team about emotional or practical concerns you have before or after surgery. Your care team can help you find support as you recover.

If you feel comfortable, bring someone with you when you talk with your care team. You may feel worried or overwhelmed during this time. Having someone with you can help you listen, ask questions and remember important information about your care.

Diet and nutrition

What you eat and how you eat after surgery for stomach cancer depend on the procedure you have. If you have an endoscopic resection, you may be able to start eating sooner than if you have surgery to remove part or all of your stomach.

If part or all of your stomach is removed, you usually start with liquids and gradually add soft foods and then more solid foods as your digestive system heals. A dietitian can help you choose foods and get the nutrition you need during recovery.

Removing part or all of the stomach can make it harder for your body to get enough nutrients. Your care team may check your levels of vitamins and minerals, including vitamin B-12, vitamin D and calcium. Some people need vitamin supplements after stomach surgery, especially vitamin B-12 if a large part or all of the stomach was removed.

Estudios clínicos

Explora los estudios de Mayo Clinic de pruebas y procedimientos para ayudar a prevenir, detectar, tratar o controlar las afecciones.