Stomach Cancer Surgery

What is Stomach Cancer Surgery?

Stomach cancer surgery is a medical procedure used to remove cancerous tissue from the stomach. It is one of the main treatments for stomach cancer and offers the best chance of curing the disease when the cancer is detected early and has not spread extensively to other organs.

The stomach is a hollow muscular organ located in the upper abdomen. It plays a key role in digestion by storing food and breaking it down before it moves into the small intestine. When cancer develops in the stomach lining, it can grow into deeper layers of the stomach wall and spread to nearby lymph nodes or organs. Surgery aims to remove the tumour along with a margin of healthy tissue to ensure that as many cancer cells as possible are eliminated.

Who is Suitable for Stomach Cancer Surgery?

Not every patient with stomach cancer will require or be suitable for surgery. The decision depends on several factors, including the stage of the cancer, the patient’s overall health, and whether the cancer has spread to distant organs.

Patients are generally considered suitable candidates for stomach cancer surgery when the tumour is localised to the stomach or nearby lymph nodes and can be removed safely.

People who may be suitable for surgery include:

• Patients with early-stage stomach cancer: When the tumour is confined to the inner layers of the stomach wall.
• Patients with localised cancer: When the tumour has not spread to distant organs such as the liver, lungs, or bones.
• Patients with good overall health: Those who are fit enough to tolerate major surgery and general anaesthesia.
• Patients without severe medical conditions: Individuals whose heart, lung, and kidney function allow safe recovery after surgery.

Doctors usually perform several tests before recommending surgery. These may include endoscopy, CT scans, PET scans, ultrasound, or biopsy. These investigations help determine the size of the tumour, how deeply it has grown into the stomach wall, and whether lymph nodes or other organs are involved.

In some cases, chemotherapy may be given before surgery to shrink the tumour and make it easier to remove. This is known as neoadjuvant chemotherapy.

Surgery may not be recommended if the cancer has spread extensively throughout the body. In such cases, other treatments may be used to control symptoms and slow disease progression.

Benefits of Stomach Cancer Surgery

Stomach cancer surgery offers several important benefits, particularly when the disease is detected early. It remains the most effective treatment for removing cancer and preventing it from spreading further.

Key benefits include:

• Potential cure: Surgery provides the best chance of completely removing the cancer when it is detected early.
• Removal of the primary tumour: Eliminating the main source of cancer cells in the stomach.
• Improved survival outcomes: Patients who undergo successful surgery often have significantly better long-term survival rates.
• Accurate staging: Removing lymph nodes allows doctors to determine how far the cancer has spread and plan further treatment.
• Relief of symptoms: Surgery may help reduce pain, bleeding, or obstruction caused by the tumour.
• Improved quality of life: Removing the tumour may allow patients to eat more comfortably and regain strength.

When combined with chemotherapy or other therapies, surgery can form part of a comprehensive treatment plan designed to reduce recurrence and improve long-term outcomes.

Minimally invasive surgical techniques may also offer additional advantages, including:

• Smaller incisions
• Reduced postoperative pain
• Shorter hospital stays
• Faster recovery

Types of Stomach Cancer Surgery

Common types of stomach cancer surgery include:

• Partial gastrectomy: Removal of the portion of the stomach that contains the tumour. The remaining stomach is then connected to the small intestine to allow digestion to continue. This procedure is commonly used when the cancer is located in the lower part of the stomach.
• Total gastrectomy: Removal of the entire stomach when the tumour involves a large area or is located in the upper part of the stomach. After the stomach is removed, the oesophagus is connected directly to the small intestine so food can still pass through the digestive system.
• Subtotal gastrectomy: Similar to partial gastrectomy but involves the removal of a larger portion of the stomach.
• Lymph node dissection: Removal of nearby lymph nodes to check for cancer spread. This step is usually performed during gastrectomy procedures.
• Minimally invasive gastrectomy: Laparoscopic or robotic techniques using small incisions and specialised instruments. These approaches may reduce surgical trauma and shorten recovery time.
• Endoscopic resection: For very early stomach cancers, specialised endoscopic techniques can remove tumours without traditional surgery. This procedure is typically used when the cancer is limited to the inner lining of the stomach.

The surgical approach will be carefully planned based on imaging studies, biopsy results, and multidisciplinary team discussions.

Alternative Options to Stomach Cancer Surgery

Although surgery is the primary treatment for many stomach cancers, other treatment options may be used when surgery is not suitable or when additional therapy is required.

Alternative or complementary treatments include:

• Chemotherapy: Anti-cancer medications used to destroy cancer cells or slow their growth. Chemotherapy may be given before surgery, after surgery, or as the main treatment when surgery is not possible.
• Radiation therapy: High-energy radiation used to damage cancer cells and reduce tumour size. Radiation is sometimes combined with chemotherapy.
• Targeted therapy: Medications designed to target specific molecular changes in cancer cells. These treatments can help slow tumour growth and improve outcomes in certain patients.
• Immunotherapy: Treatments that stimulate the immune system to recognise and attack cancer cells.
• Endoscopic treatments: For early-stage cancers, specialised endoscopic procedures may remove tumours without major surgery.
• Palliative treatments: When the cancer cannot be cured, treatment may focus on relieving symptoms such as pain, bleeding, or difficulty swallowing.

Preparation Before a Stomach Cancer Surgery

Before surgery, patients usually undergo a series of investigations to confirm the diagnosis and determine the stage of the cancer.

• Medical evaluation: Blood tests, imaging scans, and endoscopy help assess the tumour and the patient’s overall health.
• Staging investigations: CT scans, PET scans, or endoscopic ultrasound may be used to determine whether the cancer has spread to lymph nodes or other organs.
• Anaesthetic assessment: The anaesthetist evaluates heart and lung function to ensure the patient can safely undergo general anaesthesia.
• Nutritional assessment: Many patients with stomach cancer experience weight loss. Dietitians may recommend nutritional supplements to improve strength before surgery.
• Medication review: Some medications, particularly blood thinners, may need to be temporarily stopped before the procedure.
• Preoperative chemotherapy: In some cases, chemotherapy is given before surgery to shrink the tumour and improve surgical outcomes.

Patients are also advised to take several practical steps before the operation.

• Stop smoking: Smoking increases the risk of surgical complications and slows healing.
• Maintain good nutrition: Eating high-protein, nutrient-rich foods helps support recovery.
• Follow fasting instructions: Patients usually need to stop eating and drinking several hours before surgery.
• Prepare for recovery: Arranging help at home, planning time away from work, and organising transportation from the hospital can make the recovery period easier.

Stomach Cancer Surgery Procedure

Stomach cancer surgery is performed under general anaesthesia, meaning the patient is asleep throughout the procedure and does not feel pain. The specific steps of the surgery depend on the size, location, and stage of the tumour.

Once the patient is anaesthetised, the surgeon begins by accessing the stomach through either a traditional open incision in the abdomen or several smaller incisions if a minimally invasive technique is used.

The main stages of the operation generally include:

• Accessing the stomach: The surgeon carefully exposes the stomach and surrounding structures.
• Identifying the tumour: The tumour and surrounding tissues are assessed to determine the safest and most effective method of removal.
• Removing the affected portion of the stomach: Depending on the tumour location, either part of the stomach (partial gastrectomy) or the entire stomach (total gastrectomy) may be removed.
• Removing nearby lymph nodes: Lymph nodes surrounding the stomach are usually removed to check for cancer spread.
• Reconstructing the digestive tract: After the tumour is removed, the remaining stomach or oesophagus is connected to the small intestine so that food can continue to pass through the digestive system.
• Checking for bleeding and complications: The surgical team carefully ensures all connections are secure before closing the incisions.

The operation typically takes several hours, depending on the complexity of the tumour and the type of surgery performed.

In many specialist centres, minimally invasive techniques such as laparoscopic or robotic surgery may be used. These approaches use smaller incisions and specialised instruments, which may reduce pain and shorten recovery time.

What to Expect After a Stomach Cancer Surgery?

Recovery after stomach cancer surgery varies depending on the type of operation performed and the overall health of the patient. Most patients remain in the hospital for monitoring and recovery for several days following the procedure.

Immediately after surgery, patients are usually cared for in a recovery unit where vital signs such as heart rate, breathing, and blood pressure are closely monitored.

During the early recovery period, patients may experience:

• Temporary pain or discomfort: Pain relief medications are provided to keep patients comfortable.
• Intravenous fluids: Fluids are given through a drip until patients can drink normally.
• Gradual return to eating: Patients usually start with liquids before slowly progressing to soft foods and regular meals.
• Drain tubes: Temporary drains may be placed near the surgical site to remove fluid during healing.
• Early movement: Gentle walking is encouraged soon after surgery to reduce the risk of blood clots and support recovery.

After leaving the hospital, recovery continues at home. Many patients require several weeks to regain their strength.

Long-term recovery may involve:

• Dietary adjustments: Smaller, more frequent meals may be recommended because the stomach capacity may be reduced.
• Nutritional supplements: Some patients require vitamin supplements, particularly vitamin B12, iron, or calcium.
• Follow-up appointments: Regular medical reviews and scans help monitor recovery and detect any recurrence of cancer.
• Additional treatment: Chemotherapy or other therapies may be recommended after surgery to reduce the risk of cancer returning.

Most patients gradually return to normal daily activities within several weeks to months, although recovery times vary.

Stomach Cancer Surgery Prognosis

When stomach cancer is detected early and removed completely through surgery, long-term survival rates can be significantly improved. Early-stage cancers that are confined to the inner lining of the stomach often have the best outcomes.

Prognosis is influenced by several key factors:

• Cancer stage at diagnosis: Earlier stages have a higher chance of successful treatment.
• Complete tumour removal: Achieving clear surgical margins improves outcomes.
• Lymph node involvement: The number of affected lymph nodes influences long-term survival.
• Response to additional therapy: Chemotherapy or targeted therapy may improve treatment success.
• Overall patient health: Good physical condition helps patients recover and tolerate additional treatments.

Regular follow-up after surgery is important for monitoring recovery and detecting any signs of recurrence early.

Stomach Cancer Surgery Risks

As with any major operation, stomach cancer surgery carries certain risks. However, these risks are carefully managed by experienced surgical teams and modern hospital care.

Possible risks and complications may include:

• Bleeding: Some bleeding can occur during or after surgery.
• Infection: Surgical site infections may develop but are usually treatable with antibiotics.
• Leak at the surgical connection: The area where the digestive tract is reconnected may rarely leak.
• Blood clots: Immobility after surgery can increase the risk of clots forming in the legs or lungs.
• Digestive changes: Some patients experience symptoms such as early fullness, reflux, or diarrhoea.
• Nutritional deficiencies: Reduced stomach capacity may affect the absorption of certain nutrients.
• Delayed gastric emptying: Food may move more slowly through the digestive system after surgery.

Your surgical team will discuss these risks before the procedure and take steps to reduce the risk of complications.

What if Stomach Cancer Surgery is Delayed?

Delaying stomach cancer surgery can allow the tumour more time to grow and spread, which may reduce the chances of successful treatment.

Stomach cancer can gradually invade deeper layers of the stomach wall and spread to nearby lymph nodes or distant organs such as the liver or lungs. Once the cancer spreads beyond the stomach, treatment becomes more complex, and the chances of a cure may decrease.

Potential consequences of delaying surgery may include:

• Tumour growth: The cancer may increase in size and become more difficult to remove.
• Spread to lymph nodes: Cancer cells may travel through the lymphatic system.
• Metastasis: The disease may spread to distant organs.
• Worsening symptoms: Patients may experience increasing pain, bleeding, nausea, or difficulty eating.
• Reduced treatment options: Some advanced cancers may no longer be suitable for curative surgery.

Early diagnosis and timely treatment offer the best opportunity for successful management of stomach cancer. If surgery is recommended, discussing the timing and treatment plan with a specialist surgical team can help ensure the best possible outcome.