Surgery for stomach cancer

Surgery aims to remove all of the stomach cancer while keeping as much normal tissue as possible. However, it is essential to remove a small amount of healthy tissue around the cancer to reduce the risk of the cancer coming back. The type of surgery will depend on where the tumour is growing and how advanced the cancer is.

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Endoscopic resection (ER)

Small, very early-stage tumours that have not spread from the stomach walls may be removed with an endoscope. This is usually a day or overnight stay procedure. Preparation and recovery are similar to endoscopy. This may be the only treatment needed for some people with early-stage stomach cancer.

Gastrectomy (surgical resection)

This procedure removes the cancerous tissue and part or all of the stomach, leaving as much healthy tissue as possible. The goal is to completely remove the cancer, including any affected lymph nodes.

There are two ways to perform a gastrectomy:

  • in a laparotomy (open gastrectomy), the surgery is performed through a cut in the upper part of the stomach
  • in a laparoscopic (keyhole) gastrectomy, the surgeon will make some small cuts in the abdomen, then perform surgery using a thin telescope to see inside the abdomen and chest.

The hospital stay and recovery time may be similar for both types of surgery. Laparoscopic surgery usually means a smaller scar, however, open surgery may be considered a better option in many situations.

The surgery will be performed under a general anaesthetic. Your surgeon will talk to you about the risks of your procedure.

Subtotal or partial gastrectomy – The cancerous part of the stomach is removed, along with nearby fatty tissue (omentum) and lymph nodes. The upper stomach and oesophagus are usually left intact.

Total gastrectomy – Removal of the whole stomach, along with nearby fatty tissue (omentum), lymph nodes and parts of adjacent organs, if necessary. The surgeon reconnects the oesophagus to the small bowel. The top part of this connection (which is a tube of intestine) takes over some of the stomach’s function.

Lymphadenectomy (lymph node dissection) – As the cancer might have spread to nearby lymph nodes, your doctor will usually remove a number of lymph nodes from around your stomach. This reduces the risk of leaving any cancer behind.

Risks of stomach surgery

As with any major surgery, stomach surgery has risks. Complications may include: infection, bleeding, blood clots, damage to nearby organs, or leaking from the connections between the small bowel and either the oesophagus or stomach. Some people may experience an irregular heartbeat, but this usually settles within a few days.

You will be carefully monitored for any side effects afterwards. For more information about ongoing effects after surgery, see Managing side effects.

What to expect after stomach surgery

When you wake up after the operation, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be transferred to a ward where you will stay for 5–10 days until you can go home. It can take about three months to fully recover.

Pain – You will have some pain and discomfort for several days after your surgery, but you will be given pain-relieving medicines to manage this. Let your doctor or nurse know if you are in pain so they can adjust your medicines to make you as comfortable as possible. Do not wait until the pain is severe.

Wound care – You will have a dressing over the wound. Your doctor or nurse will talk to you about how to keep the wound clean once you go home to prevent it becoming infected.

Drips and drains – After surgery you will have several tubes in your body, including a catheter to measure urine output. You may have an intravenous (IV) drip, which is used for pain relief and to replace your body’s fluids until you are able to drink and eat again. You may also have a feeding tube.

Dietary changes – You will be unable to eat or drink initially after surgery. Your doctor will advise when you are able to start eating. You will usually start with fluids such as soup, and then move onto soft foods for about a week. When you are ready, you can try eating some solid foods. You may be advised to eat 6–8 small meals or snacks throughout the day. The hospital dietitian can prepare eating plans for you and work out whether you need any supplements to help meet your nutritional needs.

Sometimes, a small feeding tube is placed further down the small bowel through a small cut in the abdomen. You can be given specially prepared feeding formula through this tube while the join between the oesophagus and small bowel heals. The tube is usually removed after 3–4 weeks. For more on eating after surgery, see Managing Side Effects.

Breathing exercises – A physiotherapist will teach you breathing or coughing exercises to help keep your lungs clear. This will reduce the risk of you getting a chest infection.

Activity/exercise – Your health care team will probably encourage you to walk the day after the surgery. Exercise has been shown to help people manage some of the common side effects of treatment, speed up a return to usual activities and improve quality of life. Speak to your doctor if you would like to try more vigorous exercise. You will have to wear compression stockings for a couple of weeks to help the blood in your legs to circulate. You will most likely need to avoid driving for a few weeks after the surgery and avoid heavy lifting.

After surgery to the stomach, many people don’t absorb vitamin D and calcium well. This can lead to thinning and weakening of the bones (osteoporosis). This may cause pain and an increased risk of fractures. For more on how to prevent osteoporosis, talk to your doctor. It may also help to see a dietitian.

Feeding tubes

If you are unable to eat and drink enough to meet your nutritional needs, you may need a feeding tube. You may receive all your nutrition through this tube, or it may be used to supplement the food you eat.

Some people with stomach or oesophageal cancers will have a feeding tube before treatment to help them maintain weight and build up their strength. Other people will have a feeding tube after surgery while their wound is healing. Your doctor and dietitian will discuss your individual nutrition care needs with you.

Many people find that having a feeding tube eases the pressure and discomfort associated with eating. Medicines can also be given through a feeding tube.

A feeding tube can be placed into your small bowel either through your nostril (nasojejunal tube) or through an opening on the outside of your abdomen (known as a jejunostomy or J-tube).

If you go home with the feeding tube in place, a dietitian will advise you on the type and amount of feeding formula you will need.

Your health care team will also tell you how to keep the tube clean, how to prevent wear, leakage and blockages, and when to replace the tube. Your doctor will remove the feeding tube when it is no longer required. It can take time to adjust to a feeding tube. It may help to talk to your family, a counsellor, or nurse, or you can call Cancer Council 13 11 20 for information and support.

Video: What is surgery?

Watch this short video to learn more about surgery.

This information was last reviewed in September 2017
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