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• Gastrectomy

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Gastrectomy

A gastrectomy is surgery that removes the cancer and part or all of the stomach, depending on the type and stage of the cancer. The surgeon will try to leave behind as much normal stomach as possible. This operation is called a gastrectomy and is viewed as the most realistic chance to cure stomach cancer. If a patient’s cancer is in the early to moderate stage and is healthy enough, an attempt should be made to treat the cancer with surgery. Some patients with stage IV cancer that has not spread to distant sites may also benefit from surgery.

Even when the cancer is too widespread to be removed completely by surgery, patients may be helped from surgery because it may help prevent bleeding from the tumor or prevent the stomach from being blocked by tumor growth.

There are three kinds of surgery that may be used to treat stomach cancer:^1,2

Endoscopic mucosal resection

In this procedure, the cancer is removed through an endoscope - a long, flexible tube passed down the throat and into the stomach. This procedure is only done for certain very early stage cancers, where the chance of it spreading to the lymph nodes is very low.

Subtotal gastrectomy

A subtotal gastrectomy is often recommended if the cancer is only in the lower or the upper part of the stomach. Only part of the stomach is removed, sometimes along with part of the esophagus or the beginning of the small intestine (the duodenum). Nearby lymph nodes are also removed. The remaining section of stomach is then reattached. Eating is much easier if only part of the stomach is removed instead of the entire stomach.

Total gastrectomy

Your doctor will probably recommend a total gastrectomy if the cancer has spread throughout the stomach. It is also often advised if the cancer is in the upper part of the stomach, near the esophagus. A total gastrectomy involves removing the entire stomach, nearby lymph nodes, and possibly removal of the spleen and parts of the esophagus, intestines, pancreas, and other nearby organs.

If you have a total gastrectomy, the surgeon will make a new "stomach" out of intestinal tissue. Usually the end of the esophagus is attached to part of the small intestine, and some extra intestine is also attached. This can make room for food to be stored before moving down the intestinal tract, and will allow you to eat some food before getting full. But, people who have a total gastrectomy can only eat a small amount of food at a time. Because of this, they must eat more often.

Lymph node removal

In either a subtotal or total gastrectomy, the nearby lymph nodes and some of the omentum are usually removed. The omentum is an apron-like layer of fatty tissue that covers the stomach and intestines. Lymph node removal is a very important part of the operation. Many doctors feel that the success of the surgery is directly related to how many lymph nodes the surgeon removes.

In the United States, it is recommended that a gastrectomy be accompanied by removal of nearby lymph nodes with the goal of removing at least 15 nodes. Surgeons in Japan have had very high success rates by doing a more extensive removal of lymph nodes near the cancer. Stomach cancer is much more common in Japan, but the disease is often caught in early stages since patients are screened for stomach cancer.

It takes a skilled surgeon who is experienced in stomach cancer surgery to remove all the lymph nodes successfully. It is important that you ask your surgeon about his or her experience in operating on stomach cancer. Studies have shown the results are better when both the surgeon and hospital have extensive experience in treating patients with stomach cancer.²

Possible complications and side effects of surgery

Surgery for stomach cancer is difficult, and complications can occur. These can include bleeding from the surgery, blood clots, and damage to nearby organs during the operation. It is rare but possible that the new connections made between the ends of the stomach or esophagus and small intestine may leak.

Surgical techniques have improved in recent years, so only about 1% to 2% of patients die from surgery for stomach cancer.² This number is higher (as high as 5% to 15%) when the operation is more extensive, such as when all the lymph nodes are removed, but is lower in the hands of highly skilled surgeons.

You may develop other side effects after you have recovered from surgery. These can include frequent heartburn, abdominal pain (particularly after eating), and vitamin deficiencies. Changes in your diet will often be needed after a partial or total gastrectomy. The biggest change is that you will need to eat smaller, more frequent meals.

It cannot be stressed enough that your surgeon must be highly skilled. He or she should be experienced in treating stomach cancer and able to perform the most up-to-date operations to reduce your risk of complications.

da Vinci® Surgery for Stomach Cancer

If your doctor recommends surgery to treat stomach cancer, you may be a candidate for a safe, effective and minimally invasive procedure – da Vinci Surgery. Using the most advanced technology available, the da Vinci System enables your doctor to perform this delicate operation through a few tiny incisions with breakthrough vision, precision and control.

da Vinci Surgery offers stomach cancer patients many potential benefits, including:

• Lower risk of complications³
• Ability to perform minimally invasively on advanced cancer³

da Vinci Surgery offers patients other key benefits when compared to traditional laparoscopic surgery, including:

• Less pain⁴
• Quicker return to normal diet⁴

When compared to both traditional open and laparoscopic surgery, da Vinci offers patients additional benefits, including:

• Better short term surgical outcomes⁵
• Less blood loss⁵
• Shorter hospital stay and recovery⁵

This procedure is performed using the da Vinci Surgical System, a state-of-the-art surgical platform. By overcoming the limits of both traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for people around the world.

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As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you make the best decision for your situation.