Gastric Cancer Surgery

Gastrectomy is the mainstay of surgery for the earlier stages of Gastric cancer however we are increasingly combining this with chemotherapy. Decisions relating to chemotherapy are made in conjunction with a medical oncologist and will be discussed with you. Gastrectomy may be either partial or total depending on the location of the cancer and sometimes a palliative gastrectomy is done in advanced cases to avoid problems related to further growth of the cancer. Overall gastrectomy is the most effective treatment which aims at cure.

What happens before surgery?

Prior to having a gastrectomy for cancer it is important that we stage the cancer. This means that a number of tests are done to work out if there has been any spread of the tumour. If we find that the tumour is more advanced, chemotherapy may be required before the surgery. The tests may include a gastroscopy, CT scanning, PET scan, blood tests and often a laparoscopy to look for spread of the tumour beyond the stomach to the lining of the abdomen.

How Does the Gastrectomy Work?

As with all cancer surgery we aim to remove all the tumour. This also means removing the lymph glands and tissues surrounding the tumour. This also helps us to stage the tumour and determine what type of tumour is present. We can then decide if more treatment is required and get some idea of the prognosis.

Are there different types of gastrectomy?

Depending on the type and location of the cancer a partial or total gastrectomy is performed. These operations can be done as either an open or keyhole operation and sometimes a combination of both procedures.

Partial Gastrectomy

This type of operation can usually be done when the cancer is in the lower part of the stomach. In addition to the stomach being removed the surrounding tissue including the lymph glands are also removed. Once the lower part of the stomach is removed the small bowel is joined up to the remaining stomach to allow for eating in the usual way. After the surgery the stomach is much smaller than before and so often it is necessary to eat smaller meals more often. It is common to lose some weight after the surgery.

Total Gastrectomy

Total gastrectomy is required if the cancer is in the top part of the stomach near where the oesophagus joins the stomach or if the cancer has spread throughout the lining of the stomach.

As with partial gastrectomy the tissues including lymph nodes surrounding the stomach are removed and occasionally adjacent organs such as the spleen or lower oesophagus may require removal as well. The small bowel is joined up directly to the oesophagus. Without the stomach, oral intake is limited to having small meals and as a result these need to be regular up to six times daily.

Total gastrectomy is often undertaken as a hybrid procedure of laparoscopic and open surgery however in some circumstances a total laparoscopic procedure may be possible.

CHD1 gene

Assoc. Prof. Crosthwaite has a special interest in patients with the CDH1 gene where total gastrectomy is an important prophylactic option. He works with a team in the management of these patients.

What are the risks and complications of Gastrectomy?

Problems after Gastrectomy

  • these will be discussed with you prior to the surgery but include

Operation Risks

  • Leaks from where the bowel is joined together – fortunately this is very uncommon
  • in a partial gastrectomy sometimes the remining stomach can be slow to empty delaying discharge
  • General risks such as bleeding, infection, clots to the lungs and      anaesthetic problems
  • Overall despite this gastric surgery is very safe and the mortality rate is less than 1-2%

Long term problems

- Vitamin deficiencies – after total gastrectomy Vit B12 injections will   be required in the long term as the part of the stomach involved in      the absorption of Vi B12 has been removed.
- Weight loss is occasionally a problem and support can be given by a     dietician.
- Dumping can occur particularly after total gastrectomy.  This may         be associated with abdominal pain, diarrhoea, feeling faint and some other symptoms.  This can usually be dealt with dietary       manipulation.

Choosing your Surgeon

It is important that you choose an experienced surgeon with an interest in Gastric cancer surgery.  Assoc. Prof. Crosthwaite has been operating on gastric cancers for many years and has most recently visited Korea a world centre for the resection of gastric cancers.  He will be able to discuss all these issues with you and manage your condition with a full team including
  • Medical oncologist
  • Radiologist and oncologist
  • Dietician
  • a comprehensive and experienced surgical team
  • Obesity Surgery Society of Australia & New Zeland
  • The International Society for Diseases of the Esophagus
  •  Australia &New Zeland Gastric & Oesophageal Surgery Association
  • Epworth Healthcare
  • Fellow of the Royal Australian College of Surgeons