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.
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 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.
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.