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
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
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.
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).
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.
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
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).
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.