Surgery for Stomach Cancer: What to Expect
Treatment for all stages of stomach cancer will involve some type of surgery. However, the type of surgery will vary with the cancer stage. While gastrectomy is the most common form of stomach cancer surgery, some cancer patients may benefit from palliative surgery to relieve the symptoms and complications of advanced stomach cancer.
People with very early stage stomach cancer may be candidates for endoscopic resection. This procedure involves passing an endoscope down the throat and into the stomach. An endoscope is a flexible tube with a lighted camera. It lets your doctor view the lining of the stomach and cut out—or resect—the tumor. This surgery is only possible when the tumor is confined to the stomach lining. It is not a common treatment in the United States where most stomach cancers are advanced at the time of diagnosis.
Gastrectomy is the surgery doctors most often use in the United States for stomach cancer. It is the main treatment for stomach cancer stages I to III, usually with chemotherapy and radiation therapy beforehand. Doctors may recommend this combination after surgery as well. The type of gastrectomy you need depends on the stage and location of the cancer:
Partial, or subtotal gastrectomy may be an option for early cancers in stage I or II. If the top part of the stomach was removed, the surgeon attaches the remaining stomach to the esophagus. For removing the bottom part of the stomach, the surgeon attaches the remaining portion to the small intestine.
Total gastrectomy can be an option for stages I to III. Removing the entire stomach may be necessary when cancer is throughout the stomach. Your doctor may also recommend total gastrectomy when cancer is in the upper part of the stomach near the esophagus. After removing the stomach, doctors attach the small intestine to the bottom of the esophagus.
Regardless of the type of gastrectomy, it is major surgery and it’s helpful knowing what to expect. You will have general anesthesia and will likely spend several days in the hospital. In most cases, the surgery is a traditional open surgery with a large incision. Sometimes, doctors use laparoscopy, which is a minimally invasive technique. It allows doctors to remove the stomach through several small incisions. However, not all doctors recommend this approach as a standard treatment for stomach cancer.
The amount of preparation you need will depend on the extent of your surgery. Your doctor will give you instructions for preoperative testing and medication use. You may need to eat a clear liquid diet the day before your surgery. Sometimes, additional bowel preparation is necessary. You will also have instructions about when to stop taking anything at all by mouth, including water.
You will spend time in the pre-op area.
Hospitals commonly ask you to arrive about two hours before your surgery. This allows time to register, change your clothing, and talk with your nurses, anesthesiologist and surgeon. You will sign consent forms and have the opportunity to ask questions. Your team will start an IV and get you ready for surgery. It’s typical to go the OR (operating room) on a stretcher. You will likely have IV medicine to relax you before leaving the pre-op area. General anesthesia will start once you are settled in the OR.
A friend or family member can stay with you during the pre-op process. When your team takes you to the OR, your visitor can wait for you in the waiting area. The hospital staff will keep your visitor up-to-date about your progress.
You will spend a few hours recovering in the post-op area. Your visitor may be able to see you once you are alert. Once your vital signs are stable, the hospital staff will transfer you to an inpatient room. For a partial gastrectomy, you may have a 3- to 5-day hospital stay. A stay of a week to 10 days may be necessary after a total gastrectomy.
You will have pain.
Both kinds of gastrectomy are major surgeries that will involve pain. Pain control is important for healing. You will need to be up and walking after surgery. You will also have other recovery activities, such as deep breathing, to prevent complications. Managing your pain is vital so you can actively participate in your recovery. Tell a member of your team if your medicine is not controlling your pain.
Your digestive tract will need time to heal.
After surgery, you may have a feeding tube or IV nutrition to allow your digestive tract to heal. You will transition back to eating by starting with a liquid diet and slowly adding soft foods and regular foods. This process can take several months. Because the anatomy of your stomach has changed, you will always need to eat smaller, more frequent meals.
Expect to lose weight.
Losing weight is unavoidable after gastrectomy. After a partial gastrectomy, this usually levels out by about 4 to 6 weeks. People who have a total gastrectomy may continue to lose weight for two months. A dietitian can help by teaching you what foods to eat to meet caloric and nutritional needs. If you are not able to get enough nourishment by mouth, you may need a permanent feeding tube.
In stage IV stomach cancer, surgery can’t get rid of cancer but it can still help. The goal in this case is to relieve symptoms and control the cancer as much as possible. The name for this is palliative surgery. It can help improve your quality of life and prolong survival. Your doctor may recommend various surgeries to control bleeding, remove blockages, and reduce pain. Surgery may also be necessary to provide nutrition by placing a feeding tube. It can deliver liquid nutrition into the small intestine and bypass the stomach altogether.
All surgeries carry risk and you should understand them before agreeing to a procedure. Talk with your doctor to understand the goals of surgery and the possible complications. Together, you can plan a pathway forward that meets your needs.