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Surgery is an important treatment for many stomach cancers. The results of surgery have improved in recent years. This is because stomach cancer is being found and treated earlier, and because of advances in surgical methods.
Depending on the stage of the cancer, an operation may be all that’s needed to cure it. This may involve removing part of the stomach (a partial gastrectomy) or all of the stomach (a total gastrectomy). The operation that’s needed depends on the size of the tumour and where it is in the stomach.
The lymph nodes close to the stomach| are removed at the same time to see if any cancer cells have spread into them.
Depending on the extent of the cancer, some other organs in the area of the stomach may be removed during the operation. These may include the lower part of the gullet (oesophagus), the upper part of the small bowel (duodenum), the spleen or part of the pancreas. If the lower part of the gullet is removed, the gullet is reconnected directly to the small bowel.
View a large format version of the diagram here.|
Usually, one large cut is made during surgery to the stomach. But sometimes it’s possible to have keyhole (laparoscopic) surgery to remove some or all of the stomach. In this type of surgery, several small openings are made instead of one larger cut. The surgeon uses an instrument called a laparoscope to see and work inside the tummy (abdomen).
The laparoscope is put into the abdomen through small cuts in the skin. Generally, about three small cuts and one larger cut are needed for this operation. The larger one is used to remove the stomach.
Recovery time may be quicker with this type of surgery, but this has not yet been proven in clinical trials.
The chances of curing stomach cancer appear to be as good with keyhole surgery as with more invasive operations. However, it hasn’t been used for long enough to be absolutely sure of this.
Keyhole surgery should be carried out by surgeons with specialist training and experience in using laparoscopic techniques. This type of surgery isn’t widely available in the UK so, if it’s suitable for you, you may need to travel to another hospital to have the operation.
Sometimes the cancer may cause a blockage that stops food from passing through the gut. If this happens, the surgeon may be able to do one of the following:
Bypass the blockage by making a new connection between two parts of the gut, allowing food to get through. This is called bypass surgery.
Surgery to relieve a blockage in the stomach can often relieve symptoms| but won’t cure the cancer.
Having part or all of your stomach removed is a major operation. Before you have this type of surgery your doctors need to make sure you’re physically able to cope with it and that it isn’t too risky for you. You may need to have tests - for example on your heart and lungs - to check your general health and fitness. If you’ve been having problems with eating and have lost weight, you may be given extra help and support with your diet to help prepare you for the operation. If you smoke, cutting down or giving up smoking before your operation may reduce the chance of complications after your surgery.
You’ll be asked to fast overnight and won’t be able to eat until after the operation. You’ll have a bath or a shower and will be given a hospital gown to change into. You may also be given special support stockings to wear. These help prevent blood clots from developing in your legs during or after the operation.
You may be nursed in the intensive care or high-dependency unit immediately after your operation. This is routine in many hospitals and doesn’t mean your operation has gone badly or that there are complications.
You’ll probably have an oxygen mask on to start with to help you breathe more easily. For the first few hours after the operation a machine called a ventilator may be used to help you breathe.
The nurses will encourage you to start moving around as soon as possible after your operation. This is an essential part of your recovery, as it helps to prevent problems such as chest infections or blood clots from developing. If you have to stay in bed, the nurses will encourage you to move your legs regularly and do deep breathing exercises. A nurse or physiotherapist can help you with these. While you’re in hospital, you may also be given regular injections of a drug to help prevent blood clots. These will be given under the skin (subcutaneously).
After the operation, you may have some of the following in place for a short time:
After an operation to remove part or all of your stomach, new joins are made in your gut. These joins will need a few days to heal, so you won’t be able to eat or drink immediately after your operation.
You may have a feeding tube (jejunostomy) in place for a few days. The surgeon puts this in during surgery. It’s put into the middle part of the small bowel (jejunum) through a small cut made in the wall of the tummy (abdomen). This will be used to give you food until you are able to eat. It will be taken out soon after you have begun to eat again.
After about 48 hours you will probably be ready to start taking small sips of water. This will gradually increase until you are able to eat a light diet, usually four or five days after your operation. Before you start eating again you may have a test called a contrast swallow in the x-ray department. This involves drinking a liquid that shows up on x-rays. The test is done to check that the joins in your gut are healing properly.
After your operation you’ll need painkilling drugs for a few days. These may be given into a vein (intravenously), into the space around your spinal cord (epidural), into a muscle (intramuscularly) or as tablets.
Pain can usually be controlled effectively with painkillers|.
To begin with you may be given intravenous pain relief through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller. You may also have a handset with a button you can press if you feel sore. This is called patient controlled analgesia (PCA). It’s designed so that you can’t have too much painkiller (an overdose), so it’s okay to press it whenever you’re uncomfortable.
You may be given painkillers into the space around your spinal cord through a very fine tube placed in your back during surgery (epidural). The tubing connects to a pump, which gives you a continuous dose of painkillers.
Let your nurses and doctors know as soon as possible if you’re in pain. This will help them give you the combination and dose of painkillers that’s right for you.
You will probably be ready to go home about 7-14 days after your operation. If you think you may have problems when you go home - for example, if you live alone or have several flights of stairs to climb - let your nurses or social worker know when you go into hospital. They can arrange help for you when you go home.
You’ll be recovering for some time after you go home and will need to take things easy for several weeks. It’s best to gradually build up your level of activity. It’ll probably be three to six months before you’re fit enough to go back to work.
Provided you feel comfortable to do so, it’s usually fine to begin driving again from four to six weeks after your operation.
It’s usually safe to have sex again from about four weeks after the operation, but it depends on how you feel.
Some people take longer than others to recover from their operation. If you’re having any problems you may find it helpful to talk to someone who is not directly involved with your illness. Our cancer support specialists| will be happy to talk with you. They can also give you details of support groups in your area where you can talk to other people who have had similar experiences. You may find our Online Community| a source of support.
Before you leave hospital you’ll be given an appointment for a post-operative check-up at the outpatient clinic. This will be a good time to talk to your doctor about any problems you may have after your operation.
Content last reviewed: 1 June 2011
Next planned review: 2013
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
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© Macmillan Cancer Support 2013
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