If you have stomach (gastric) cancer, gastrectomy is often an important part of your treatment. You may also have a gastrectomy if you have a CDH1 genetic mutation that increases your risk of developing stomach cancer. The goal of stomach cancer surgery is to eliminate the cancer or your risk of developing it. Surgery can also improve your quality of life.
Penn Medicine is a regional leader in gastrectomy to treat existing cancers and in prophylactic gastrectomy to reduce stomach cancer risk. Our experienced gastrointestinal (GI) cancer team helps you understand your personal risk and make the right treatment decisions for you.
What Is a Gastrectomy?
Gastrectomy is surgery to remove all or part of the stomach. It changes the way you eat because your body must digest food differently.
We can treat some small gastric tumors that have not spread with gastrectomy alone. But if the tumor has become more advanced, your stomach cancer treatment may include a combination of surgery and chemotherapy with or without radiation.
There are two kinds of gastrectomy: partial gastrectomy and total gastrectomy. The location and stage (extent) of the tumor help determine the type we recommend for you. You might also choose to have a prophylactic gastrectomy — a type of total gastrectomy — if you have a CDH1 genetic mutation.
Gastrectomy Surgery for Stomach Cancer: Why Choose the Abramson Cancer Center?
At Penn, your care team includes stomach cancer experts, including GI surgeons, chemotherapy specialists and genetic counselors. These experts work closely with your other providers to ensure you receive coordinated and complete care.
Your care also includes:
- Experienced surgeons: You receive care from surgeons who specialize in gastrectomy. They are among the most experienced and skilled in the country. We care for the most people who have a CHD1 genetic mutation in the region. This uncommon expertise means you're in the hands of a surgery team who has seen it all — and can customize care to your specific needs.
- Minimally invasive options: We offer laparoscopic-assisted partial and total gastrectomies. These procedures require smaller incisions and often lead to a quicker return to daily activities.
- Team Approach: In our regular GI tumor board meetings, leaders in all areas of stomach cancer care come together to discuss difficult cases. Their collaboration leads to personalized, effective treatment plans informed by the latest research.
- Comprehensive support: Removal of the stomach is major surgery and requires significant lifestyle changes. We prepare you for surgery and any quality-of-life changes through comprehensive counseling and nutrition support. We also offer the region's only support group for patients with CDH1 genetic mutations. This group connects you with other people who have had or are thinking about having a total gastrectomy. You experience education, friendship, recipes and more.
- Genetic counseling: In our Gastrointestinal Cancer Genetics Program, we offer expert cancer risk evaluation and genetic testing. Our genetic counselors work closely with you and your care team to help you make informed decisions about reducing your stomach cancer risk.
Gastrectomies and Stomach Cancer Surgeries We Offer
Stomach cancer surgeries we offer include:
Staging (Diagnostic) Laparoscopy
If you have stomach cancer that has started to spread, you may first receive neoadjuvant (before surgery) chemotherapy to shrink the tumor. Shrinking the tumor increases the chance that we can successfully remove it.
Before you begin these chemotherapy treatments, you undergo an outpatient procedure called staging laparoscopy. During it, your surgeon:
- Inserts a thin tube with a fiberoptic camera (laparoscope) into your abdomen through a tiny incision
- Examines the area around your stomach, abdominal cavity and the lining of your abdomen
- Takes tissue samples to check for cancer (biopsy)
Staging laparoscopies can confirm the stage and any spread of the cancer. These minimally invasive procedures help us reinforce your treatment plan, giving you the best chance for a good outcome.
Partial (Subtotal Distal) Gastrectomy
A partial gastrectomy involves the removal of part of your stomach. Our doctors do partial gastrectomies when the stomach cancer is in the lower portion of the stomach (distal stomach). The location of the tumor determines how much of the stomach your surgeon removes.
During a partial gastrectomy, your surgeon:
- Divides your stomach into two sections
- Removes the lower half of the stomach, along with the tumor and nearby lymph nodes
- Sends the lymph nodes to a pathologist (lab specialist) for examination to determine if the cancer has spread
- Reconstructs your GI tract by bringing a loop of intestine up to your stomach, creating a new connection for food to pass through during digestion
Most patients undergo partial gastrectomy as an open surgery under general anesthesia. But some are candidates for a laparoscopic-assisted partial gastrectomy. This minimally invasive procedure requires smaller incisions and often helps you recover faster.
Total Gastrectomy
A total gastrectomy involves the removal of your entire stomach. Then your surgeon attaches your esophagus to your small intestine. This process creates a new connection for food to pass through.
Our doctors do total gastrectomy when the stomach cancer is in the upper portion of the stomach (proximal stomach). This location requires surgeons to divide the lower part of the esophagus and remove the stomach. More rarely, they may do a partial gastrectomy to remove just the proximal stomach and any tumors.
Most patients undergo a total gastrectomy as an open surgery under general anesthesia. But some may be candidates for a laparoscopic-assisted approach.
Prophylactic Gastrectomy
Fifty to 80 percent of people with the CDH1 gene mutation go on to develop stomach cancer. These cancers tend to spread more easily. That's why doctors recommend prophylactic (preventive or risk-mitigating) total gastrectomy for people who have this mutation. Read more about the CDH1 mutation and stomach cancer risk.
Deciding to have a prophylactic gastrectomy is a big decision. Most patients are healthy at the time of surgery. Gastrectomy also requires significant lifestyle changes, especially to what and how you can eat.
To help you make the best decision for you, we meet with you several times for detailed discussions about what to expect. We also connect you with other patients who have gone through prophylactic gastrectomy so you can get their perspective.
Preparing for a Gastrectomy
Being in the best possible health before a gastrectomy will make your recovery easier. You should participate in regular aerobic exercise and eat a balanced diet. We can develop an exercise and nutrition plan that's best for you.
We give you specific instructions on when to stop eating, drinking and taking medications in the days and weeks before your surgery. You need to have an empty stomach before any surgical procedure that requires anesthesia.
These guidelines are for your safety. If you don't follow the instructions, we may cancel your surgery.
Recovering from a Gastrectomy
The recovery process depends on how much of your stomach doctors remove. For both partial and total gastrectomy:
- You can't eat anything within the first few days after surgery.
- You get nourishment through an IV or feeding tube. This gives your digestive tract time to heal.
- Later, you progress to a liquid diet, then a soft food diet, until you can handle harder foods.
Life After Partial Gastrectomy
If you are having a partial gastrectomy, you can expect to spend up to five days recovering in the hospital after surgery. You'll likely lose weight in the month after surgery as well. You can usually resume your normal eating schedule within six months.
Life After Total Gastrectomy
If you are having a total gastrectomy, you spend about six to 10 days in the hospital recovering. You then receive close follow-up, coaching and support for several months after surgery.
You work with your cancer team, including a registered dietitian, throughout your recovery. Our goal is to ensure you are getting adequate nutrition and recovering well.
You can expect to lose 15 to 20 pounds overall. You may also develop new food intolerances and nutritional deficiencies that we can help you address.
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