Surgery is an important treatment, especially for early stomach cancer. It should only be carried out by specialist surgeons. It isn’t available in all hospitals, so you may need to go to a different hospital to have it done.
Even when the cancer has spread outside the stomach to the surrounding area, it may still be possible to remove it. This involves major surgery and some people may not be physically well enough to have it. You need to talk to your surgeon about the benefits and risks of this operation before making a decision about it.
Most people need treatment with chemotherapy as well as an operation. Sometimes, surgery may be the only treatment that’s needed. This is usually when stomach cancer is diagnosed at the earliest possible stage. Or it may be because having chemotherapy and surgery would be too intensive and hard to cope with.
The operation you have depends on where the cancer is in the stomach and its size. You may have all or part of the stomach removed. The surgeon also takes away an area of healthy tissue around the cancer, to try to make sure all the cancer cells are gone. They also remove nearby lymph nodes and the fatty tissue called the omentum that covers the stomach and the front of the bowel.
Depending on the position of the cancer and how far it has spread, the surgeon may remove part of some nearby organs. This may include the lower part of the gullet (oesophagus), the upper part of the small bowel (duodenum) and occasionally the spleen or part of the pancreas.
Surgery to remove part of the stomach
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Depending on the position and size of the cancer, it may be possible to keep part of the stomach. This is called a partial gastrectomy. Having this operation makes eating easier after surgery.
If the cancer is in the lower stomach near the small bowel
The surgeon removes the lower part of the stomach. They then sew up the duodenum (the first part of the small bowel, which used to attach to the lower stomach). They move the upper part of your stomach down and reconnect it to a different part of the small bowel, forming a smaller stomach.
If the cancer is in the upper stomach near the gullet
The surgeon removes the upper stomach and the lowest part of the gullet. This operation is called an oesophagogastrectomy. They join the remaining end of the gullet to the lower end of the stomach.
Surgery to remove all of the stomach
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If the cancer is in the upper or middle part of the stomach, you’ll usually have the whole stomach removed. This is called a total gastrectomy. The surgeon joins the bottom of the gullet to part of the small bowel, making a small sac that can act as a stomach.
The duodenum, which used to connect to the bottom of the stomach, is sewn up at the end.
In some situations, it may be possible to have keyhole or laparoscopic surgery to remove some, or all, of the stomach. The surgeon does this operation through several small cuts in the abdomen, rather than one large opening. They use a laparoscope, which they put through the cuts to see and work inside the tummy.
Generally, about three small cuts and one larger cut are needed for this operation. The surgeon removes the stomach through the larger cut.
With keyhole surgery, people may recover faster, but this hasn’t been proven in clinical trials yet. The chances of curing stomach cancer seem to be as good with keyhole surgery as with more invasive operations. But keyhole surgery hasn’t been used for long enough to be certain, so doctors still need to do more research on this.
Keyhole surgery for stomach cancer is only available in some hospitals in the UK. It should only be carried out by surgeons with specialist training and experience.
Surgery to relieve a blockage
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Sometimes, the cancer causes a blockage that stops food from passing through the stomach. Usually, the doctor treats this by putting a thin tube (stent) into the area where the blockage is, to allow food to pass through. They do this under a local anaesthetic using an endoscope that goes down the gullet and into the stomach.
Another way of treating a blockage is by removing the part of the stomach where the blockage is (partial gastrectomy).
Or, the surgeon may do an operation to bypass the blockage by making a new connection between two parts of the gut. This allows food to get through a different way.
Surgery to relieve a blockage can often relieve symptoms but won’t cure the cancer.
Before surgery to remove part or all of your stomach
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Having part or all of your stomach removed is major surgery. You’ll need to have tests to make sure you’re physically well enough. These are usually done a few days to two weeks before your operation at a pre-assessment clinic. They include tests on your heart and lungs.
A member of the surgical team and a specialist nurse will talk to you about the operation. You may see the doctor who gives you the anaesthetic (the anaesthetist) at a clinic or when you’re admitted to hospital.
If you smoke, it’s important to try to give up or cut down before your operation. This will help reduce the risk of problems such as getting a chest infection. It will also improve wound healing after the operation. Your GP can give you advice on quitting smoking.
A dietitian will give you advice on eating well in preparation for the operation. If you’ve had problems with eating and have lost weight, you may need extra help and support with your diet.
Let the nurses know as soon as possible if you think you might need help when you go home after your operation. This may be because, for example, you live alone or are a carer for someone else. The staff can help you make arrangements in plenty of time.
Many hospitals now follow what’s called an enhanced recovery programme. This aims to reduce your time in hospital and speed up your recovery. It involves you more in your care. For example, you’ll be given information about exercises you can do to help you get fitter before surgery. And any arrangements needed for your return home will be put in place in advance. Your doctor will tell you if an enhanced recovery programme is suitable for you and if it’s available – not all hospitals have one.
You’ll usually be admitted to hospital the morning of your operation. The nurses will give you special elastic stockings (TED stockings) to wear during and after the operation. These help prevent blood clots in your legs.
One of the most important things you can do before surgery is make sure you’ve asked all the questions you want to and discussed any concerns with your nurse or doctor.
You may be cared for in a high-dependency unit for a few days after your operation. This is routine in many hospitals and doesn’t mean your operation has gone badly or that there are complications.
The nurses will encourage you to start moving around as soon as possible. You’ll usually be helped to get out of bed the day after your operation. While you’re in bed, it’s important to move your legs regularly and do deep breathing exercises. This helps to prevent chest infections and blood clots. A physiotherapist will show you how to do the exercises.
Drips and tubes
After the operation, you may have some of the following in place for a short time:
A drip (infusion) into a vein in your arm or neck to give you fluids until you’re eating and drinking again.
A thin tube going into your back to give you painkilling drugs that numb the nerves and stop you feeling sore (called an epidural).
A tube that goes up your nose and down into your stomach (nasogastric tube) which the nurses use to remove fluid so you don’t feel sick.
A feeding tube (jejunostomy), which goes into the small bowel through a small cut in the abdomen.
A small, flexible tube into your bladder to drain urine into a bag (urinary catheter).
A drainage tube to remove fluid from your wound, allowing it to heal properly.
Drinking and eating
You won’t usually have anything to drink for the first 24–48 hours. When you’re able to drink enough, you’ll start to have light foods and then normal food in smaller sized meals. This gives the new joins made during surgery some time to heal.
You may have a feeding tube to give you liquid food for a few days until you’re eating well. Some people go home with the feeding tube and have it a bit longer, to make sure they put on weight.
There are effective ways to prevent and control pain after surgery. For the first few days you’ll have painkillers either into a vein (intravenously) or into your back (epidural).
Intravenous pain relief is given through an electronic pump to give you a continuous dose of painkiller. It’s called patient-controlled analgesia (PCA). You can give yourself an extra dose by pressing a button if you feel sore. The machine is set to make sure you can’t have too much.
With an epidural, the anaesthetist puts a fine tube into your back during surgery. They connect the tube to a pump to give you a continuous dose of painkillers.
When you no longer need the epidural or PCA, you have painkillers as tablets.
Let your nurses and doctors know if you’re in pain, so they can give you the dose of painkillers that’s right for you.
The nurses usually keep your wound covered with a dressing for the first few days. They’ll check it regularly to make sure it’s healing well. After about ten days, they’ll remove your staples or stitches.
You’ll probably be ready to go home about 10–14 days after your operation. You’ll still be recovering for some time after you go home and will need to take things easy for a few weeks. Avoid lifting heavy loads like shopping, or doing vacuuming or gardening for at least eight weeks to give your wound time to heal.
Try gradually building up the amount you do, as you feel able. Gentle exercise like taking regular walks will help to build up your energy. You can increase the amount you do as you feel better. Some people take longer than others to recover. It depends on your situation so don’t be hard on yourself.
If you feel able, it’s usually fine to drive four to six weeks after your operation. Some insurance policies give specific time limits. It’s a good idea to contact your car insurers to check you’re covered before driving again.
If you feel ready, it is usually fine to have sex from about four weeks after the operation.
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You’ll have an appointment for a post-operative check-up at the outpatient clinic. The ward staff may give you this appointment before you leave hospital.
The doctor will check on your recovery and talk to you about the results of your operation. This is a good time for you to talk about any problems you’ve had after the operation, although you can contact them sooner if you are unwell or worried about anything.
You can contact your specialist nurse if you need advice or support after your operation.
Sometimes it can be helpful to talk to someone who’s not directly involved in your situation. Call our cancer support specialists on 0808 808 00 00 if you need to talk. They can also give you details of support groups in your area.
You may also find our Online Community helpful. There, you can talk to others who are going through similar experiences.