Types of Stomach Cancer Surgery

If you have stomach (or gastric) cancer and are discussing treatment options with your cancer care team, your doctors may recommend that you undergo surgery. While all this new information about surgical procedures can be overwhelming and difficult to digest, understanding the various types of surgery is very useful. Not only will it help you stay on top of medical discussions, but it can also prepare you for what to expect before surgery.

Surgery refers to a medical procedure where a part of your body is cut open by your doctors to remove, repair or replace diseased or damaged tissue. It is a common form of cancer treatment. This article covers surgery for gastric adenocarcinomas, which are the most common type of gastric cancer.

Depending on factors such as the stage of your cancer, the aim of surgery could be either curative or palliative.

Curative

If the cancer has limited spread, surgery (usually combined with other treatments) is the best possible way to cure cancer completely. This explains why it is traditionally the first-line treatment for gastric cancer and is recommended by doctors whenever possible.

Curative surgery is achieved by removing the tumor(s) entirely. More often than not, nearby lymph nodes and tissues are also removed.

Palliative

When the cancer has spread to distant parts of the body and cannot be removed completely and safely with surgery, curing the disease is, unfortunately, unlikely. The goal of surgery is then to control symptoms, relieve any blockages and slow tumor progression. This can improve the patient’s quality of life and ease any discomfort as the cancer progresses. This is known as palliative surgery.

There are different types of surgery that can be used to remove cancerous tissue. The type of surgery recommended to you will depend on factors such as the location and size of the cancer and the extent of its spread. The curative surgical procedures used to treat gastric cancer include endoscopic resection and partial or total gastrectomies.

Endoscopic resection

Minimally-invasive procedures of this kind involve the insertion of a thin, tube-like instrument called an endoscope down the esophagus and into the stomach. Surgical cutting tools passed through the tube are then used to remove the tumor. Endoscopic resection (ER) is typically used to remove early-stage cancers that have not infiltrated deeper layers of the stomach wall and are unlikely to spread outside the stomach.

There are two types of ER procedures — endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR is used for small, early-stage gastric cancers and precancerous growths that are limited to the stomach mucosa and unlikely to affect nearby lymph nodes. Meanwhile, ESD is mainly used to remove early-stage tumors that are larger and have spread into the submucosal layer, which is deeper than the mucosa of the stomach wall. In both procedures, a small margin of healthy tissue around and below the tumor is removed as well.

Partial or total gastrectomy

A gastrectomy is a surgical procedure where your stomach is removed. Depending on the location of the cancer in your stomach and how far it has spread, your doctors will decide if you are due for a partial or total gastrectomy. The latter involves removal of the entire stomach, whereas in the former, only part of the stomach is resected.

Surgical approaches to a gastrectomy

There are two surgical approaches that your surgeon can use when it comes to performing a gastrectomy: open or laparoscopic surgery.

> Find out more about these surgical approaches and how they differ

Detailed below are some medical procedures used as part of palliative surgery for gastric cancer.

Partial or subtotal gastrectomy

For people fit enough for surgery, removing the region of the stomach with the tumor can aid in alleviating problems like pain or bleeding. If the tumor is blocking food from passing through the stomach, a gastrectomy can also aid in relieving this blockage. However, because the goal of surgery is not curative, removing nearby lymph nodes and tissues is typically not needed.

Gastrojejunostomy

Some gastric tumors located in the lower region of the stomach can grow so big that they block the opening into your small intestine. In these cases, your doctors may perform a procedure called a gastrojejunostomy. This involves connecting the upper part of the stomach to the jejunum, which is the middle part of the small intestine. Also known as a gastric bypass, a gastrojejunostomy allows food and other stomach contents to enter the jejunum directly from the stomach without passing through the duodenum, which is the upper part of the small intestine. A subtotal gastrectomy can sometimes be done at the same time to remove the part of the stomach that is cancerous.

Feeding tube placement

If you’re suffering from gastric cancer, chances are you experience some difficulty in eating or drinking. If you are not receiving adequate nutrition, your doctors can perform a minor operation to insert a feeding tube through your skin and into the lower region of your stomach (called a gastrostomy or G tube) or into your small intestine (called a jejunostomy or J tube). Subsequently, liquid nutrition and medication are administered directly through the end of the tube located outside of your abdomen.

Endoscopic procedures

In some cases, extensive surgery may not be required as part of palliative care. Instead, upper endoscopic procedures can be performed to relieve symptoms. These include:

• Endoluminal stent placement: In this procedure, a thin, hollow tube called a stent is inserted using an endoscope to keep a passage (such as the esophagus or small intestine) open. In the case of tumors located in the upper (proximal) stomach, the stent is placed at the gastroesophageal junction where the esophagus and stomach meet. On the other hand, for tumors located in the lower (distal) stomach, the stent is inserted at the junction between the stomach and small intestine. This allows food to pass through these passages.
• Endoluminal laser therapy or endoscopic tumor ablation: This procedure, which helps to relieve blockages and stop bleeding, is meant for people who are not fit for surgery. It involves inserting an endoscope into the body. Attached to the end of the endoscope is a laser, which can be used to vaporize or burn away parts of the tumor. This is often used in the treatment of gastroesophageal cancers.

Depending on the stage of your cancer, surgery might be the best option to ensure your overall health. However, surgery is not an easy process as it entails pre- and post-operative care. It can be physically and mentally challenging to go through this part of your cancer journey. The good news is that you can always rely on your cancer care team for support and guidance. They can provide you with every resource you need to make your journey more comfortable and less stressful.