Surgical Approaches to a Gastrectomy for Stomach Cancer
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Often performed as part of stomach (or gastric) cancer treatment, a gastrectomy is a surgical procedure where all or part of the stomach is removed. Depending on the location of the cancer in your stomach and how far it has spread, your doctors will decide whether you need a partial or total gastrectomy to treat your type of gastric cancer.
How is a gastrectomy performed?
There are two surgical approaches to a gastrectomy, which are open surgery (laparotomy) and laparoscopic (or keyhole) surgery.
Open surgery
To access your stomach, a single, large incision (cut) known as a laparotomy is made in the upper part of your abdomen, just below the breastbone down to the belly button. After removing all or part of the stomach, the incision is closed with staples or sutures.
Laparoscopic (or keyhole) surgery
This surgical approach is typically offered in specialist cancer centers with specially trained surgeons. During this minimally-invasive procedure, several small incisions are first made in the abdomen. Through one of the incisions, your surgeon will insert a thin, lighted tube with a tiny video camera at its tip. This is known as a laparoscope. The use of this instrument allows images of the inside of your abdomen to be projected on a screen, which your surgeon uses for guidance as they perform the operation. Through the other incisions, long surgical tools are inserted and used to remove all or part of your stomach.
Your cancer center may offer a particular type of laparoscopic surgery called robot-assisted laparoscopic surgery. Also known as robotic gastrectomy, this minimally-invasive procedure involves an advanced surgical device with surgical instruments mounted on the ends of robotic arms. An additional arm consists of a camera that generates magnified, high-definition, three-dimensional images of the inside of your abdomen. These images are displayed on a screen to help guide your surgeon during the procedure. After inserting the surgical instruments and camera through small abdominal incisions, your surgeon controls these tools from a console in the operating room and uses them to perform the gastrectomy.
Is one approach better than the other?
Operating time with the laparoscopic approach (including robot-assisted surgery) may take a few hours longer than open surgery. However, it has been associated with a faster recovery and fewer complications during and after surgery. People who have undergone this minimally-invasive procedure generally experience less blood loss and postoperative pain, minimal scarring and are able to return to gastrointestinal function within a shorter span of time.
However, it should be noted that trials comparing open and laparoscopic gastrectomy have been on a smaller scale and are almost exclusive to high-volume cancer centers with highly-experienced laparoscopic surgery experts. Therefore, many doctors feel that it is necessary to study the laparoscopic technique further before it can be regarded as a form of standard treatment for gastric cancer.
In the United States, laparoscopic and robotic gastric surgery are considered emerging rather than established technologies, while the traditional approach of open surgery remains the gold standard in the surgical management of gastric cancer.
When is each surgical approach used?
Which approach your surgeon chooses to perform your gastrectomy will depend on the size of your gastric tumor and whether the cancer has spread to other parts of the body.
Your surgeons will likely recommend an open gastrectomy if you:
- have advanced, resectable gastric cancer that involves nearby lymph nodes and other neighboring organs. This is because it is typically easier to remove affected lymph nodes and surrounding organs during open surgery.
- have scar tissue on your abdomen resulting from a previous procedure. The creation of small incisions, which is an essential part of laparoscopic surgery, can be challenging because of this scar tissue.
On the other hand, the laparoscopic approach is more suitable if you:
- have early-stage gastric cancer that is less aggressive with smaller tumors that have not spread to stomach wall layers beyond the submucosa, and
- have not undergone previous upper abdominal surgery.
