Surgery is a common procedure used to treat stomach cancer, also called gastric cancer. When there is no metastasis, surgery is usually done in conjunction with other approaches (such as immunotherapy or chemotherapy) to offer a better chance of cure.
Depending on the location and stage of the cancer, this surgery can be done to remove the tumor, part of the stomach, or the entire organ, as well as lymph nodes and other structures present in the region.
If the cancer is already widespread, preventing it from being removed completely, surgery is done to prevent the stomach from being blocked by tumor growth or from causing bleeding. This type of surgery can prevent or alleviate symptoms, but it does not cure the cancer.
Types of Surgery
Different types of surgical techniques can be used in an attempt to eliminate gastric cancer. The choice will depend on what part of the stomach the tumor is located in and how far it has grown and reached neighboring regions.
The main types of surgical techniques in the management of stomach cancer are:
- Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) – procedures that can be used to treat some very early stage gastric cancers, when the tumor has not yet deepened into the stomach wall and the possibility of spreading outside this organ is still low. They do not require an incision in the skin, as they are done through an endoscope (a long, flexible tube that carries a micro-camera at its end) inserted down the throat into the stomach. The surgical instruments needed to remove the tumor and some layers of the stomach wall are passed through the endoscope. Usually, the ESD technique allows you to reach deeper layers of the stomach compared to the EMR;
- Subtotal (partial) gastrectomy – with this technique, only part of the stomach is removed. It is usually recommended if the cancer is located only in the lower part of the stomach (distal gastrectomy) or restricted to the upper part of the stomach (proximal gastrectomy). Part of the stomach is removed, and in certain cases, it may be necessary to remove part of the esophagus or small intestine as well. The omentum, the layer of fatty tissue that lines the stomach and intestines, is also removed, as well as the lymph nodes in the region and, if necessary, the spleen; and
- Total gastrectomy – this surgery is chosen when the cancer has already spread completely throughout the stomach. The stomach, the adjacent lymph nodes, and the omentum are completely removed. If necessary, also the spleen and parts of the esophagus, intestine, pancreas, and other organs affected by metastases.
Most gastrectomies are performed through a large incision in the skin of the abdomen, popularly known as open surgery. However, the procedure is increasingly being performed by videolaparoscopy, in which surgical instruments are inserted into the abdomen through small incisions and the doctor manipulates them through a high-definition screen. This modality has the advantages of a faster recovery and a shorter hospitalization time, but some doctors consider that it still needs to be further refined for stomach cancer.
In both total and subtotal gastrectomy, the lymph nodes in the region are removed. This procedure is called lymph node dissection or lymphadenectomy and is considered an important step in the treatment.
If the cancer is non-resectable, i.e. cannot be completely removed, surgery can be done to control its growth or to help relieve symptoms or complications. Palliative surgery may be a gastric bypass, a subtotal gastrectomy, or a gastrojejunostomy (insertion of a feeding tube).
Possible Adverse Effects of Cancer Surgery
Gastric cancer surgery is a safe but complex procedure that can have complications, such as blood clots and injury to nearby organs. As for recovery, the process will depend on the extent of the surgery, that is, how much of the stomach needed to be removed.
Weight loss, adjustment to a new diet, and vitamin replacement are some of the changes gastrectomy patients need to be prepared for. Intestinal cramps, pain, diarrhea, and dizziness can occur after eating – this is called dumping syndrome, caused by the rapid movement of food and drink through the digestive system.
For this reason, nutritional monitoring in the postoperative period is fundamental to ensure the patient’s quality of life.