Surgery to remove all or part of your stomach

Surgery to remove your stomach is called a gastrectomy.  There are different types of gastrectomy. The type you have depends on the stage and position of your cancer. 

You might have:

• a subtotal or partial gastrectomy - your surgeon removes part of your stomach
• a total gastrectomy - your surgeon removes your whole stomach
• an oesophagogastrectomy - your surgeon removes your stomach and the part of your food pipe (oesophagus) 

Your surgeon will also remove some of the nearby lymph nodes. This helps to reduce the risk of cancer coming back. They might need to remove part of some nearby organs to remove all the cancer. This depends on how far your cancer has grown. 

You might need to travel to a specialist centre to have your surgery.

What type of surgery do I need?

The type of surgery you need for cancer of the stomach depends on:

• the stage and type of your cancer
• where it is in your stomach

An operation to remove your stomach cancer is major surgery. You have it under general anaesthetic, so you are in a deep sleep.

Most people need surgery to remove all or part of their stomach. You won’t need a stoma (bag). 

For very small, early cancers you might have endoscopic surgery to remove part of the lining of your stomach. Your surgeon removes this using a long flexible tube (endoscope). You might have an endoscopic mucosal resection (EMR) or an endoscopic submucosal dissection (ESD).

Removing part of the stomach

Your surgeon may remove up to two thirds of your stomach if the cancer is at the lower end of your stomach. This is called a subtotal or partial gastrectomy. How much the surgeon removes depends on the position of the cancer. The surgeon will also remove part of the sheet of tissue that holds the stomach in place (omentum).  

The surgeon joins your small bowel to the remaining part of your stomach. 

The duodenum is the first part of your small bowel which connects to the stomach. The surgeon reconnects the far end of the duodenum to the small bowel. 

You have a smaller stomach afterwards. The valve (cardiac sphincter) between your oesophagus and stomach will still be there.

Removing the stomach

This operation is for when the cancer is in the middle of the stomach. The surgeon removes the whole stomach and all of the omentum. This is a total gastrectomy with a Roux-en-Y reconstruction. Your surgeon rejoins your oesophagus to your small bowel.

Removing the stomach and part of the food pipe

This operation is for cancer that is in the area where the stomach joins the oesophagus.  The surgeon removes the top part of your stomach and part of your oesophagus. This is an oesophagogastrectomy.

Your surgeon keeps the lowest third of your stomach and makes it into a tube. They rejoin this tube with the remaining part of your oesophagus.

Removing lymph nodes

During your operation the surgeon examines the stomach and surrounding area. They take out all of the lymph nodes from around your stomach and along the main blood vessels to the stomach.

The surgeon takes out lymph nodes in case they contain cancer cells that have spread from the main cancer. Taking the nodes out reduces the risk of your cancer coming back in the future. It also tells your doctor how well chemotherapy has worked, and gives them more information about how far your cancer has spread (the stage).  This can help them make treatment decisions. 

The number of lymph nodes a surgeon removes might vary from person to person. For people who are less fit the surgeon may only remove the lymph nodes closest to the stomach.

How your surgeon does your operation

To remove cancer of the stomach you may have open surgery or keyhole (laparoscopic) surgery. The multidisciplinary team (MDT) will discuss the best option for you. Most people have open surgery.

Open surgery

Open surgery means the surgeon makes a larger cut in your tummy. Where the cut is depends on the type of surgery you have and where the cancer is in your stomach. The types are:
•    subtotal gastrectomy, which means having the operation through a cut in your tummy (abdomen)
•    total gastrectomy, which is when the surgeon makes one cut to your tummy to remove the whole of your stomach
•    thoraco-abdominal oesophago-gastrectomy, which means the surgeon has to remove the stomach and oesophagus though a cut in your tummy and chest

Depending on which operation you have, you may have:
•    one vertical scar on your tummy (vertical)
•    one scar like an upside down V on your tummy (rooftop)
•    one scar across your chest either on the left or the right (chest scar) and one down the middle of your tummy

Keyhole surgery

Keyhole surgery is also called minimally invasive surgery or laparoscopic surgery.  It means having an operation without needing a major cut in your tummy (abdomen).

It is possible for a surgeon to remove the whole of your stomach, or part of it, using keyhole surgery.

You have this type of surgery in specialist centres by a specially trained surgeon. The surgeon makes 4 to 6 small cuts in your tummy. They use a long tube called a laparoscope.

Having keyhole surgery

The laparoscope connects to a fibre optic camera. This shows pictures of the inside of the body on a video screen. The surgeon puts the laparoscope into one of the incisions. And they put the other instruments through the other incisions. They use these instruments and the laparoscope to carry out the operation in your body.

The surgeon frees the stomach so they can remove all or part of it. They then either join the remaining stomach to your bowel. Or they join the oesophagus to your bowel if they removed your whole stomach.