Surgery is the treatment option for many kinds of stomach cancer and a part or the whole of the stomach will need to be removed, depending on the location and site of the cancer. It is also necessary to remove lymph nodes around the stomach at the same time. Research shows that the more lymph nodes are removed, the higher the survival rate.
Partial or total gastrectomy is often used to treat gastric adenocarcinoma, gastric lymphoma, and leiomyosarcoma, which is a rare cancer. The most common stomach cancer is adenocarcinoma, but it is harder to treat than gastric lymphoma, which is less common. Patients with gastric lymphoma have higher survival rates when treated with gastrectomy.
Gastrectomy for cancer can be done as open surgery or as minimally invasive surgery. The advantage of an open method is that it can be used to treat all stages of stomach cancer, from early stage to a more advanced state. The disadvantage is that the incision is much bigger and there is usually more pain associated with this procedure. Recovery is also slower and the patient will need to stay in hospital longer than with a minimally invasive procedure. There is also a higher risk of excessive bleeding as well as more bruising to tissue.
When it comes to minimally invasive surgery, there are two types: laparoscopic and robot-assisted. Both methods have the same principles and both involve 5-6 small incisions, measure just 0.5-2 centimeters, in the abdomen. One incision is often enlarged to remove part of or all of the stomach. The advantage of this procedure is that the incisions are small, so pain is minimal and recovery is quicker. Patients can often return home more quickly than those who undergo open surgery. Bleeding is also usually less and there is less impact to tissue. The limitations of minimally invasive surgery are that it can only be done for early stage to locally advanced stage cancer; it is too complicated for advanced disease, but an experience surgeon may still be able to use this method. Robot-assisted surgery is a new technology that allows for high accuracy. The surgeon controls the robot arm through a computer and guides it using a high-definition camera that provides three-dimensional images. In some cases, minimally invasive surgery may be switched to an open surgery.
Gastrectomy is done using general anesthesia so you will be asleep during the procedure and will not feel any pain. After the anesthesia is in effect, a catheter will be inserted to allow the team to monitor your urine output. A small tube will be inserted through your nose and down to your stomach. Then, depending on the size and location of the cancer and the type of surgery, the surgeon will begin the procedure. Some or all of the stomach will be removed, along with surround lymph nodes. The remaining stomach will be attached to the small intestine. If the cancer is in the top part of the stomach, that will be removed and the bottom part of the stomach will be attached to the esophagus. If the entire stomach is removed, the intestine is then attached to the esophagus.
Sometimes gastrectomy may be a treatment option for severe ulcers/gastroenteritis or complications of disease. Normally ulcers in the stomach and intestines are treated with medication, but in patients with other complications, surgery may be appropriate. Candidates for surgery include those who don’t respond well to medication, those with bleeding in the stomach or perforation of the stomach, and those with obstruction in the stomach.
Surgery for ulcers that don’t respond to antacids involve an antrectomy and vagotomy to reduce the production of acid in the stomach, which causes ulcers. For bleeding in the stomach that doesn’t respond to medication, treatment involves endoscopy to close up any wounds to stop the bleeding and vagotomy to stop the production of acid. In the case of a perforation, treatment is the same—stitches to close the wound and vagotomy to sever the vagus nerve. All of these can be done with open surgery or minimally invasive surgery, with risks and benefits as mentioned above.
Non-Cancerous Growth Treatment
In the case of gastrointestinal stromal tumor (GIST), leiomyoma, large polyps, etc., wedge resection may be an appropriate treatment option where most of the stomach can be left intact. Lymph nodes do not need to be removed in this case as this type of growth does not spread to other parts of the body. A minimally invasive technique is recommended for non-cancerous growths, whether it be laparoscopic or robot-assisted.
Morbid Obesity Treatment
In the case of an obese patient who is unable to control their body weight with non-surgical options, such as diet control, medication, and exercise, and whose body mass index (BMI) is more than 37.5 or 32.5 with other medical conditions, such as diabetes, hypertension, and heart disease, they may be suitable for gastrectomy for weight loss. The most popular surgery is sleeve gastrectomy and gastric bypass. Both are performed with a minimally invasive technique, whether laparoscopic or robot-assisted.