Surgery for stomach cancer
Surgery is often used to treat stomach cancer. The type of surgery you have depends mainly on the size and location of the tumour. When planning surgery, your healthcare team will also consider other factors, such as:
- the type of stomach cancer
- your age
- how well your organs are working
- your nutritional status (a measure of how well your body’s nutritional needs are being met)
Surgery may be done for different reasons. You may have surgery to:
- try to cure the cancer by completely removing all of the tumour and surrounding lymph nodes
- reconstruct the gastrointestinal (GI) tract after the stomach has been removed (this is done at the time of the original surgery)
- ease symptoms of advanced stomach cancer (palliative treatment)
Evaluation before surgery @(Model.HeadingTag)>
People need to be as healthy as possible before they have surgery for stomach cancer because it can be a difficult operation that may be hard to recover from. A person with stomach cancer is thoroughly evaluated before surgery. The following may be included to make an evaluation:
A complete medical history and physical exam may be done. Tell the surgeon if you’ve had previous surgeries in the abdomen. This may affect the ability to safely remove the stomach and reconstruct the gastrointestinal tract.
Blood tests, such as a complete blood count, blood chemistry, coagulation (blood clotting) profile, and liver and kidney function tests may be done.
Heart and lung function tests are done to make sure you are healthy enough to have surgery. You may learn special coughing and breathing exercises to help keep your lungs clear. It is very important to quit smoking at least one month before surgery. Smoking can increase your risk of lung infection (pneumonia), poor wound healing, stroke and blood clots.
A nutritional assessment is done to find out your weight and how much food you’ve been eating. People with stomach cancer may be malnourished and underweight if they were unable to eat before being diagnosed. You may need nutritional supplements, a feeding tube or intravenous (IV) feeding before and after surgery to gain weight and improve your nutrition and health.
The following types of surgery are used to treat stomach cancer. You may also have other treatments before or after surgery.
Endoscopic mucosal resection @(Model.HeadingTag)>
Endoscopic mucosal resection (EMR) is a very specialized surgery used to treat small (less than 2 cm) early stage stomach cancer that has not spread beyond the inner lining of the stomach (called the mucosa). EMR is done using an
If cancer cells are on or near the cut surface of the tissue removed by surgery (called positive surgical margins), you will have more surgery to remove the stomach. If no cancer is found on or close to the margin, you will have an endoscopy every year to check the lining of the stomach for recurrence (to see if cancer has come back).
In Canada, very few stomach cancers are treated this way because stomach cancer is rarely found at such an early stage.
Laparoscopic staging and exam @(Model.HeadingTag)>
Laparoscopic staging and exam is done using a
Limited surgical resection @(Model.HeadingTag)>
A limited surgical resection (also called a wedge resection) removes a section of the stomach wall that contains the tumour along with a healthy margin around the tumour. A limited surgical resection is sometimes used to treat small (less than 3 cm) early stage stomach cancer.
Often an endoscopy is used with a limited surgical resection to locate the exact position of the tumour. A limited surgical resection may be done by open surgery to the abdomen (called a laparotomy) or by laparoscopy.
A gastrectomy is the most common surgery to treat stomach cancer. A gastrectomy is the
removal of all or part of the stomach through an incision in the abdomen. Sometimes
other organs or structures like the spleen or
There are different types of gastrectomy. A total gastrectomy removes all of the stomach. A partial gastrectomy removes part of the stomach, usually the upper (proximal) or lower (distal) half. The type of gastrectomy will depend on the location of the tumour in the stomach and the stage of the cancer.
Most people will have a gastrectomy done through a large incision in the abdomen
(laparotomy). In recent years, some surgeons are removing the stomach by
Lymph node dissection @(Model.HeadingTag)>
Lymph node dissection (removal) is classified by the location of the lymph nodes that are removed. A D1 lymph node dissection removes the lymph nodes attached to the outer wall of the area of the stomach that contains the tumour. A D2 lymph node dissection removes D1 lymph nodes plus the lymph nodes around several large blood vessels near the stomach. A D2 lymph node dissection is a longer and more complicated operation.
Palliative surgery @(Model.HeadingTag)>
Surgery may be used to relieve the symptoms of advanced stomach cancer, including:
- the inability to eat
- obstruction, or blockage (tumour may block the passage of food into or through the stomach)
- perforation (tumour may grow through the wall of the stomach, creating a hole into the abdomen)
The type of palliative surgery will depend on your symptoms, the location of the stomach tumour and your overall health, nutrition and
Stomach bypass surgery @(Model.HeadingTag)>
Surgery may be done to change the flow of food or fluids around a stomach tumour that is blocking the stomach or esophagus. The part of the stomach that is above the blockage is cut and then reattached to the small intestine. This allows the food to move through the stomach and into the small intestine. Stomach bypass surgery is also called a gastrojejunostomy.
Stomach bypass surgery may be done if you cannot have a gastrectomy because of health problems or if removing the tumour would not improve your quality of life.
Limited surgical resection @(Model.HeadingTag)>
A limited surgical resection (described above) may also be used for people with advanced stomach cancer. The goal in this case is to remove as much of the tumour as possible to try to relieve a blockage or bleeding that is hard to stop.
Placement of a stent @(Model.HeadingTag)>
A stent is a hollow metal or plastic tube. Stents may be used if a tumour is blocking the opening of the stomach near the esophagus. It will allow a person with advanced stomach cancer to swallow more easily. A stent may also be placed at the opening to the duodenum, to allow the food to pass from the stomach into the small intestine.
The doctor places the stent using an
Endoscopic tumour ablation @(Model.HeadingTag)>
Endoscopic tumour ablation uses laser surgery to destroy some of the stomach tumour. This technique may be used in people who can’t have surgery. This may be done to stop bleeding or to relieve a tumour blockage in people with advanced stomach cancer. This procedure may also help a person to eat more easily.
Feeding tube placement @(Model.HeadingTag)>
If other surgery or other methods cannot relieve a blockage caused by a stomach tumour, a person with advanced stomach cancer may have a feeding tube placed through a surgical opening in the abdomen. A feeding tube may also be used for a short time after surgery for stomach cancer.
A feeding tube is used to give liquid nutrition to help maintain a healthy weight. The tube may also be used to give medicines. A feeding tube may be placed into the:
- stomach (called a gastrostomy tube, or G-tube)
- small intestine (called a jejunostomy tube, or J-tube)
Surgery for a bowel obstruction @(Model.HeadingTag)>
A bowel obstruction is when the small intestine or colon is partly or completely blocked. The blockage prevents food, fluids and gas from passing through the intestines normally. If you have a bowel obstruction, you may need surgery to remove or bypass the part of the intestine that is blocked.
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