Stomach Cancer Surgery

The operation removes part or all of the stomach together with the fatty apron and the lymph nodes that surround it, and then reconstructs a route for food using a loop of small intestine.

How much of the stomach comes out depends on where the disease sits. Growths in the lower part allow a partial removal that leaves a working pouch behind; those near the top usually require the whole stomach to be taken, with the oesophagus joined directly to the small bowel. The lymph node clearance is a defined anatomical dissection and is as important to the result as removing the stomach itself.

Surgery is rarely the whole plan. Chemotherapy before the operation, continued afterwards, is the standard approach for most people, and the sequence is decided by a team meeting that includes a medical oncologist. Your surgeon may also perform a short camera inspection of the abdomen as a separate first step, to confirm that the operation will achieve what it is intended to before committing you to it.

You are admitted a day or two beforehand. Nutrition is assessed and often supplemented in advance, because going into an operation of this size underweight worsens every part of the recovery.

The operation is under a general anaesthetic and takes three to five hours. It may be done open, through a cut in the upper abdomen, or by keyhole, and your surgeon will explain which is planned for you. An epidural is commonly placed for pain relief, and a fine feeding tube is often passed into the small bowel during surgery so that nutrition can be given while the join heals.

You wake in a high-dependency or intensive care bed for the first night or two. Drains, a urinary catheter and the feeding tube are all normal. Water by mouth starts after a few days, sometimes after a scan has checked the join, and diet builds up slowly from there. Most people stay seven to ten days.

This is a long recovery. Expect six to twelve weeks before you feel substantially back to normal, and longer to regain the weight.

Eating is the work of the recovery. Your stomach is smaller or absent, so the old pattern of three meals will not fit. Six to eight small meals a day, eaten slowly, chewed well, with drinks taken between meals instead of with them, is the pattern that works. A dietitian will see you before discharge and again afterwards, and following that advice closely is what limits the weight loss. Most people lose some weight permanently.

No heavy lifting for six weeks. Driving at three to four weeks. Desk work at six to eight weeks, physical work considerably later. If the whole stomach has been removed you will need vitamin B12 by injection for the rest of your life, because the stomach makes the factor needed to absorb it, and iron and calcium are monitored for the same reason. Chemotherapy, where it is planned, usually restarts six to twelve weeks after surgery once you have recovered enough to tolerate it.