Surgery for stomach cancer
You may have surgery to remove a stomach cancer. Or if cancer is stopping food passing into the stomach, you may have surgery to help keep the stomach open.
Surgery for early-stage stomach cancer should only be done by specialist surgeons. It is not available in all hospitals, so you may need to travel to a hospital further away from home to have the operation.
Even when the cancer has spread outside the stomach to the surrounding area, it may still be possible to remove it.
This is major surgery, and you may not be well enough to have it. Talk to your surgeon about the benefits and risks of this operation before making a decision.
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. This is called a gastrectomy. 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. The area of healthy tissue is called a margin.
They also remove nearby lymph nodes and the omentum. The omentum is the fatty tissue that covers the stomach and the front of the bowel.
The surgeon may remove parts of some nearby organs. This depends on the position of the cancer and how far it has spread. This may include:
- the lower part of the oesophagus (the tube that connects the mouth to the stomach)
- the upper part of the small bowel (duodenum)
- the spleen or part of the pancreas.
Most people need treatment with chemotherapy as well as surgery, but sometimes surgery is the only treatment needed. This is usually when stomach cancer is diagnosed at the earliest possible stage. Or it may be because you are not well enough to have both chemotherapy and surgery.
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.
A total gastrectomy is when the surgeon removes the whole stomach. It is usually used if the cancer is in the upper or middle part of the stomach.
We have more detailed information about total and partial gastrectomy.
Before your operation, you will have tests to make sure you are well enough. These are usually done a few weeks before surgery at a pre-assessment clinic. They include tests on the heart and lungs.
Your surgeon and a specialist nurse will talk to you about the operation. You may see the doctor who gives you the anaesthetic (anaesthetist) when you are at a clinic or when you go into hospital for the operation.
If you think you might need help when you go home after your operation, tell your specialist nurse as soon as possible. For example, tell them if you might need help because you live alone or are a carer for someone else. Your healthcare team can help organise support before you go home.
You will usually go into hospital on the morning of your operation. Or you may go in the night before.
The nurses give you special elastic stockings (TED stockings) to wear during and after the operation. These help prevent blood clots in your legs.
Before surgery, it is important to make sure you have all the information you need. The operation can be complex so it is fine to ask lots of questions. Talk to your surgeon or specialist nurse if there is anything you do not understand.
Enhanced recovery programme
Many hospitals now have enhanced recovery programmes. This aims to reduce your time in hospital and speed up your recovery. It also involves you more in your own care. For example, you are given information about exercises you can do to help you get fitter before surgery, as well as exercises to do after your operation.
It also makes sure any arrangements needed for your return home are organised in advance.
Your cancer doctor will tell you if an enhanced recovery programme is suitable for you.
You will probably be cared for in a high-dependency unit for a few days after your operation. You will probably feel quite tired, and may not remember much about the first day or two after your operation.
Drips and drains
You may have some drips and drains attached to your body for a few days after surgery. These include the following:
A central venous catheter (CVC or central line)
A CVC is a thin, flexible tube that is put into a large vein in the neck, upper chest or groin. It can stay in place for up to a week. It is used to give you fluids and medicines until you can eat and drink again. It can also be used to take blood samples without using a needle.
A naso-gastric tube
A feeding tube (jejunostomy)
An abdominal drain is a tube that is put into the abdomen to help drain fluid and prevent swelling.
A urinary catheter is a tube that is put into the bladder to drain urine into a collecting bag. It can be removed as soon as you can get up and walk around.
Reducing the risk of complications
The nurses will encourage you to get out of bed and move around as soon as possible. This helps reduce the risk of complications after surgery, such as blood clots and infections. The nurses can help you manage your drips and drains while walking.
A physiotherapist or nurse will teach you deep breathing exercises to help keep your lungs clear. They will also show you how to do regular leg movements to prevent blood clots forming in your legs.
A physiotherapist can also show you how to clear your lungs of any fluid that may have built up because of your operation.
You will probably have some pain and discomfort after the operation. Your cancer doctor or specialist nurse will explain how your pain will be controlled.
You may have painkillers in one of the following ways:
Into the space around the spinal cord (epidural)
The painkillers are given through a very fine tube that the surgeon places into your back during surgery. The tube connects to a pump, which gives you a continuous dose of painkillers.
Patient-controlled analgesia (PCA)
A painkiller is given through a pump that you control. This allows you to give yourself an extra dose of pain relief when you need it.
When you no longer need the epidural or PCA, you have painkillers as tablets or liquids.
It is important to tell your healthcare team if you are still in pain. Mild discomfort or pain in your chest can last for several weeks, so they will give you some painkillers to take home with you.
You will probably have a dressing covering your wound, which might not be removed for the first few days.
How long the wound takes to heal depends on the operation you had. The surgeon may have closed your wound with glue or stitches that dissolve and do not need to be removed. If you do not have stitches that dissolve, they are usually removed about 7 to 10 days after your operation.
Tell a nurse or your cancer doctor straight away if your wound becomes:
- leaks any fluid.
Eating and drinking after surgery
You will usually go home with your feeding tube still in, to make sure you get enough food and nutrients and do not lose weight. Before leaving hospital, your nurse or dietitian will show you how to use your feeding tube. If you have a carer, they can learn how to use it too. You will see the dietitian regularly as an outpatient to check how well you are eating. When you are eating and drinking enough, the tube can be removed.
We have more information about feeding tubes and nutritional support.
Sometimes the cancer causes a blockage that stops food from passing through the stomach. Your cancer doctor may suggest putting a tube (stent) into the stomach. This can help keep the stomach open, so food can pass through it more easily. A stent can be placed:
- in the opening at the top of the stomach
- at the lower end of the stomach, where it opens into the small bowel.
You will have a local anaesthetic, which is given as a spray to the throat. Or you may have some medicine to make you sleepy (sedation). Sometimes a general anaesthetic may be used. The doctor puts an endoscope down the oesophagus and into the stomach. They can then pass a stent into the area where the blockage is, to allow food to pass through.
Sometimes the surgeon does an operation to bypass the blockage. They do this by making a new connection between the stomach and small bowel. This allows food to pass through a different way.
Surgery or stents can be used to relieve a blockage and symptoms, but will not cure the cancer. Your doctor or nurse will talk to you about what to expect after your surgery and how to prepare for it.