Surgery for stomach cancer

Surgery is an important treatment for stomach cancer. Even if the cancer has spread outside the stomach, it might still be possible to remove it. This is major surgery and some people may not be physically well enough to have it. Most people will need chemotherapy as well as surgery.

You may have surgery to remove all or part of the stomach. During the operation, the surgeon also removes an area of healthy tissue and some nearby lymph nodes. This is to try to make sure that all the cancer cells are gone. If the cancer has spread, the surgeon may also remove part of some nearby organs.

Your doctor will talk to you about the operation and what to expect afterwards. If you’re not sure about anything, it’s important that you ask. You can also discuss any concerns you have about the operation.

If you do decide to have the surgery, your medical team will give you advice about the best way to prepare for it.

Surgery for stomach cancer

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. 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.

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.

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. This is 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 to remove all the cancer. 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.


Before surgery to remove part or all of your stomach

Having part or all of your stomach removed is major surgery. You will have tests to make sure you are well enough for the operation. These include tests on your heart and lungs. They are usually done a few days to two weeks before your operation at a pre-assessment clinic. 

A surgeon 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 stopping smoking.

A dietitian will give you advice on eating well to help you to get ready for the operation. If you’ve had problems eating and have lost weight, you may need extra help and support with this.

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 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 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.


Surgery to remove part of the stomach

Depending on the position and size of the cancer, it may be possible to keep part of the stomach (the white area in the diagram below). 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 be attached 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.

The lower stomach is removed and the rest of the stomach is reconnected to the small bowel
The lower stomach is removed and the rest of the stomach is reconnected to the small bowel

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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 oesophago-gastrectomy. They join the remaining end of the gullet to the lower end of the stomach.

The upper stomach is removed and the lower stomach is moved up and joined to the gullet
The upper stomach is removed and the lower stomach is moved up and joined to the gullet

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Surgery to remove all of the stomach

If the cancer is in the upper or middle part of the stomach, you’ll usually have the whole stomach removed (the white area in the diagram below). This is called a total gastrectomy. When the stomach is removed, the small bowel is connected to the gullet.

The duodenum, which used to connect to the bottom of the stomach, is sewn up at one end. The other end is reconnected to the small bowel.

All of the stomach is removed and the gullet is joined to the small bowel
All of the stomach is removed and the gullet is joined to the small bowel

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Keyhole (laparoscopic) surgery

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 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, several 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 in the stomach

Sometimes, the cancer causes a blockage that stops food from passing through the stomach. Usually, the doctor treats this using a thin tube (stent). Your doctor will first give you a local anaesthetic and sedation before passing an endoscope down the gullet and into the stomach. The doctor can then pass a stent into the area where the blockage is to allow food to pass through. Sometimes a general anaesthetic may be used.

Another way of treating a blockage is by removing the part of the stomach where the blockage is (partial gastrectomy).

Sometimes, 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 or stents can be used to relieve a blockage and symptoms, but won’t cure the cancer.

Back to Surgery explained

After your operation

The nurses and doctors will monitor you carefully after your operation. You may be in hospital for 10–14 days.

Eating after your operation

After surgery for stomach cancer, it may take time to adjust and eat well again. Your doctor or dietitian can give you advice.