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 what is it


The operation you have to remove your stomach cancer will depend on where in the stomach the cancer is.  You may have a

partial gastrectomy

total gastrectomy

oesophagogastrectomy 

These are all major operations and it takes time to get over them.  Your doctor must be sure you are fit enough to get through an anaesthetic and long operation, and make a good recovery.

If your cancer has spread to another part of your body, you are less likely to have any of these operations as they will not cure your cancer.  But you may have an operation to bypass or remove part of the tumour if it is blocking your gullet (oesophagus) or stomach.


Partial gastrectomy

If your cancer is at the end of the stomach that connects with the duodenum you may have only part of your stomach removed.  This is called a partial gastrectomy. After the operation you will have a much smaller stomach but the valve (cardiac sphincter) between your gullet (oesophagus) and stomach will still be there. The scar from the operation will be across your abdomen.  There are 2 different types of this operation.  They are called Bilroth 1 and Bilroth 2.  Bilroth 1 operations are not done very often these days.  They are only used for very small tumours in the lower part of the stomach (the pylorus). 

bilroth1(before)

bilroth1(after)

bilroth2(before)

bilroth2(after)



Total gastrectomy

If your cancer is in the middle of the stomach you may need to have all your stomach removed.  This operation is called a total gastrectomy. After the operation your gullet will be joined directly onto your small bowel. The scar from the operation will be up and down (vertical) or across your abdomen (horizontal).  This operation is called a Roux-en-Y reconstruction.

roux-en-y(before)

roux-en-y(after)

Oesophagogastrectomy

If your cancer is near where your stomach is joined to your gullet (oesophagus) you may need part of your gullet removed as well.  This is called oesophagogastrectomy.  The top portion of your gullet will be joined to your small bowel in a  reconstruction called a 'Roux-en-Y' (see diagram above).

Sometimes, with this operation, the furthest third of your stomach is kept and formed into a tube.  In this case, your remaining oesophagus will be joined onto this remaining part of your stomach. Because your gullet has to be operated on, you will have a bigger scar than for the other stomach operations.  The first part of the scar will run across part of your chest, along one of the ribs.  The other part will run down the middle of your tummy (abdomen).

oesophagogastrectomy(before)

oesophagogastrectomy(after)


Removing lymph nodes

During your operation you will have all of the lymph nodes close to your stomach tumour removed.  This is because they may contain cancer cells that have broken away from the main cancer.  Taking them out reduces the risk of your cancer coming back in the future.  Your surgeon may call this a D1 lymph node dissection.

Taking more lymph nodes out from further away is called a D2 dissection.  This includes the nodes along the main blood vessels supplying the stomach.  But surgeons in the UK do not do this operation routinely because there isn't any evidence yet that it lowers the risk of the cancer coming back any further.  It takes longer and is a bigger operation.  This is still a matter of debate and the research goes on.  Surgeons will only consider a D2 resection in very fit patients who have a long life expectancy should the cancer not come back and where it is possible to get all the cancer out.

What happens if my stomach is removed?

If only part of your stomach is removed you will have to eat small amounts of food more often, at least for a while, until your system learns to cope with a smaller stomach capacity.  The stomach that is left will gradually stretch so that you can eat more at a time.

If your whole stomach is removed, you may eventually return to eating normally, but this will take longer.  You will also have to have injections of vitamin B12 for the rest of your life to prevent anaemia and nerve problems.  There is more about diet after stomach surgery in the Living with Stomach Cancer section of CancerHelp UK.

It is common to have diarrhoea for some months after stomach surgery.  This can be very upsetting and you may feel weak for a time.  There is more about coping with diarrhoea in the Living with Stomach Cancer section.

 

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