Stomach Cancer: Surgery

Three surgeons in a surgery suite

Stomach cancer may be treated with surgery. The goal of it is to take out the tumor and an edge or margin of healthy tissue around it. 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. Another less common option is an endoscopic resection.

Is surgery right for you?

Your healthcare provider may suggest surgery if it may help cure your 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. 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 your body far away from your stomach.

  • You’re healthy enough for the surgery.

In some cases, surgery may not be able to cure the cancer. In this case, your healthcare provider may suggest surgery to ease or prevent some symptoms of cancer. This type of surgery 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. This is rare.

Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you.

Side effects of surgery for stomach cancer

You may have side effects when all or part of the stomach is removed. They can include:

  • Heartburn

  • Pain in your belly (abdomen)

  • Nausea

  • Diarrhea, especially after eating

Over time, the side effects may improve or go away. Talk with your healthcare provider about any side effects you have. He or she can help you manage them.

Types of surgery used to treat stomach cancer

Endoscopic resection

In this surgery, your healthcare provider puts a long, thin tube (endoscope) down your throat to your stomach. Through the endoscope, your healthcare provider can see the inside of your stomach. Then he or she uses special tools to remove the cancer. Some very early stage stomach cancers 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. Still, some cancer centers in the U.S. offer this procedure. If you have an endoscopic resection for stomach cancer, do it at a center with experience in this technique.

Subtotal or partial gastrectomy

A subtotal or partial gastrectomy means that part of your stomach is removed. It’s 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’s left to the esophagus and small intestine. He or she may also remove the following:

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

  • Part of the layer of fatty tissue that covers your stomach and intestines (omentum)

  • Part of your small intestine

  • Nearby lymph nodes

  • Part of other tissues and organs near your stomach

Total gastrectomy

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

The surgeon removes the following:

  • 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

  • Spleen

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. You may receive special high-nutrient liquids through the tube.

Palliative surgery

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

Subtotal or partial gastrectomy

Part of your stomach with the cancer is removed, but nearby organs and lymph nodes are not taken out. This can help ease symptoms, such as blockages or bleeding. 

Gastric bypass (gastrojejunostomy)

The upper part of your stomach is attached to part of the small intestine. This surgery is done to ease symptoms (like blockages) from cancer in the lower part of the stomach.

Endoscopic procedures

An endoscope is passed down your throat, through the esophagus and into your 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. These procedures may be used in people who are too sick to have surgery.

Feeding tube placement

The feeding tube may be placed directly into your stomach or small intestine. The tube exits your body through your skin over your abdomen. 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’ll talk with your surgeon. Your surgeon may be a general surgeon, gastrointestinal surgeon, or surgical oncologist. 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 complications of the surgery.

  • How you’ll eat after surgery.

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

You’ll also talk with an anesthesiologist. This is the healthcare provider who will give you the general anesthesia. This medicine 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 medicines.

Before surgery, tell your healthcare team if you’re taking any medicines. This includes over-the-counter medicines, vitamins, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery.

What to expect during surgery

On the day of surgery, you’ll be taken into the operating room. Your healthcare team will include your anesthesiologist, surgeon, and several nurses. 

During a typical surgery:

  • You’ll be moved onto the operating table. 

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

  • You’ll 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’ll receive anesthesia through an intravenous (IV) tube in your hand or arm.

  • When you’re asleep, your surgeon will do the surgery.

What to expect after surgery

You’ll wake up in a recovery room. Your healthcare providers will watch you closely. They will give you medicine to treat pain. You won’t be able to eat or drink for a few days or more after surgery. This is to give your stomach time to heal.

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:

  • Pain. The pain can be managed with medicine.

  • Tiredness or weakness. How long it takes to recover from surgery is different for each person.

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

After this surgery you may:

  • Learn how to care for and use 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 after you heal from the surgery

You will have follow-up checkups with your surgeon and other healthcare 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 healthcare team.

When to call your healthcare provider 

Talk to your healthcare team about signs of problems that you should watch for after surgery. Make sure you know how to reach them after office hours and on weekends. Let them know right away if you have any of these problems:

  • Bleeding

  • Redness, swelling, or fluid leaking from the incision

  • Fever

  • Chills