Stomach Cancer Surgery: Everything You Need To Know

Gastric or stomach cancer is a type of cancer that develops inside the stomach. This disease starts as abnormal cell growth in the first, innermost layer where the stomach stores and digests food. As these cells progress into cancer, they grow and spread through all five layers, eventually spreading to other areas of the body. When this occurs, it's called metastasis. The main goal in treating stomach cancer is to prevent the spread of the disease.

Stomach cancer surgery is often the first line of defense in preventing metastasis. When stomach cancer is found in the early stages, surgery can help remove all cancerous cells and reduce the likelihood of recurrence.¹ In this article, we will cover everything you need to know before, during, and after stomach cancer surgery.

When is stomach cancer surgery an option?

Stomach cancer, like all other types of cancer, is defined in stages. These stages explain how far cancer has spread. The stage also determines the best course of treatment and whether surgery is a good plan.

There are five primary stages of stomach cancer:

• Stage 0 – This is the earliest stage of the disease. It is often called carcinoma in situ.²

• Stage I – Cancer has spread through multiple layers of the stomach but has not spread to other nearby organs.²

• Stage II - Cancer has spread to the stomach wall, muscle, or connective tissue and up to 15 nearby lymph nodes.²

• Stage III – Cancer has spread to other tissues, organs, and lymph nodes near the stomach.²

• Stage IV – The latter stage of the disease. This is where stomach cancer has spread through the body. This is called metastasis.² Learn more about stage IV.

There are several different treatment options for stomach cancer. These include chemotherapy, targeted therapy, immunotherapy, radiation, clinical trials, and surgery.

Surgery is most commonly used during the early stages in hopes of reducing further spread. In these cases, if the cancer is aggressive, the doctor will likely combine other stomach cancer treatments and therapies. This approach can increase the overall survival rate.¹ ³

In some cases, surgery is not the best option. This is more likely to happen in the late stages, where stomach cancer has already spread throughout the body. The patient will need to discuss if surgery could do more harm than good. Stomach cancer surgery is not always the best fit.

Why treat stomach cancer with surgery

In many cases, treating early-stage stomach cancer with surgery removes cancer completely. However, this is not a guarantee that you will be cancer-free or cured.

Cancer removal is only considered successful if it has not spread throughout the body and enough of the surrounding tissue can be removed. With timely surgery, you could take away cancer’s ability to grow bigger and possibly stop it in its tracks.

Sometimes surgery is necessary for palliative care. This type of surgery is not about trying to "cure" stomach cancer. Instead, the point is to relieve pain or blockages that can lower the quality of life. Palliative surgery is especially important for patients in later-stage cancers who want to enjoy the time they have left. In some cases, this can extend their time.

Types of stomach cancer surgeries

There are a few different types of stomach cancer surgery. The type of surgery needed will depend on several factors, including the patient’s health, stage of cancer, and patient preferences. For aggressive or advanced cases, there are two main options:

Partial gastrectomy

Also known as subtotal gastrectomy, this involves removing part of the stomach, nearby lymph nodes, and any affected tissues. The remaining section of the stomach will be attached to the jejunum, the second part of the small intestines.³

Total gastrectomy 

This involves removing the entire stomach. The surgeon may also remove lymph nodes, other organs, and tissue near cancer. Once the stomach is removed, the esophagus will need to be attached to the small intestines to allow food to pass through.³

Less aggressive and early-stage cancers may do better with these less invasive surgery options:

Laparoscopy

This is a type of surgery that uses a device called a laparoscope. This is a thin, lighted tube with a camera. It is inserted through the skin of the abdomen and allows surgeons to have direct visualization of the abdominal content. This is a less invasive way to do surgery with a shorter recovery time.³

Robot-assisted

This approach uses a robotic surgical tool that the surgeon controls.³

Preparing for stomach cancer surgery

After you have scheduled your surgery, you will need to undergo presurgical testing. This is usually done about 30 days before your surgery and involves imaging, bloodwork, and any tests your doctor needs before surgery.⁴

If you take specific prescriptions, supplements, or over-the-counter medications, your doctor will need to know. Some medications need to be stopped one week before surgery due to the risk of bleeding. However, you shouldn't stop taking prescribed medication without first talking to your doctor.

Your surgeon will need you to have an empty stomach for surgery. This means that you will need to go on a clear liquid diet for 24-hours before surgery.⁴ You can ask your doctor for a complete list of safe-to-eat foods. Here are a few options you can choose from:

• Clear broths with no seasonings, herbs, or solids

• Clear apple juice

• Soda (Sprite, 7up, ginger ale)

• Water

It is important to remember that you can't have anything after midnight before your stomach cancer surgery unless your doctor approves.⁴

The doctors and specialists involved

If you have been diagnosed with stomach cancer, you will have a lot of trained healthcare professionals working together. This multidisciplinary team will work with you to create a treatment plan. Your team may include:

• Gastroenterologist

• Surgical oncologist

• Medical oncologist

• Radiation oncologist

• Anesthesiologist

• Pathologist

• Radiologist

• Nurses

• Nursing assistants

Depending on where you receive care, you may also need to see other specialists, like nutritionists, counselors, and social workers.⁵

Recovering after stomach cancer surgery

After surgery, you will not be able to eat for at least two days. This is to allow your incisions time to heal. After that, you will need to be on a liquid diet, again, until you are given the all-clear to eat solids. When this happens, you will need to eat small meals and take them slowly. This is because your stomach size has changed, and your body will not be able to handle large meals.

Success rates for stomach cancer surgery

Success rates for stomach cancer treatments vary depending on the stage of cancer at diagnosis. If you include stages 0-IV, the relative five-year survival is 32.4%.⁶ If you are only looking at those patients that caught the stomach cancer earlier, at stage I, the relative survival is much higher at 69.9%⁶

The lowdown

If you or someone you care about has been diagnosed with stomach cancer, you may be wondering if surgery is an option.

Stomach cancer surgery is one of the more successful treatment methods because it removes as much cancer as possible. This includes any affected lymph nodes, organs, or surrounding tissue.

The sooner the cancer is discovered, the higher the chances of survival. It is important to discuss all your treatment and surgery options with your healthcare team, including whether you're a good fit for any current clinical trials.