Stomach Surgery

Stomach surgery called surgical resection is the only effective therapy for curing stomach cancer. Consideration for stomach surgery is given to all patients with a good performance status and no major medical contraindications to surgery. Necessary considerations by both the health care team and the individual include morbidity, nutritional issues, and post stomach surgery rehabilitation.

Prior to stomach surgery, it is necessary to correct abnormal hematologic conditions and establish an adequate hydration and nutritional status. Patients should receive blood transfusions for significant anemia or oral iron supplementation for borderline anemia.

Improving nutritional status requires extensive planning since weight loss, emaciation, and malnutrition can adversely affect post stomach surgery healing and recovery. Improvement of the nutritional status through entereal feeding is the preferred route, but more aggressive measures using hyperalimenatation may be necessary in some cases.

The choice of stomach surgery procedure is based on the location and extent of the disease. Gastric neoplasms should not be considered unresectable or incurable based on the size of the tumor, but may be determined unresectable based on the involvement of other organs, vital blood vessels, and distant metastasis.

Lymphatic spread is recognized as a major prognostic indicator of stomach cancer although great controversy exists over the extent of lymph node dissection that should take place. In Japan, where the incidence of stomach cancer is very high, extensive lymph node dissection is utilized during surgery and cure rates are higher than in the US.

Nonetheless, it should be noted that due to mass screening programs throughout Japan for the past 25 years, stomach cancer is often detected in the early stages which allows for increased survival rates. Researchers in the US have studied this difference and concluded that a more extensive lymphadenectomy does not necessarily improve survival; it in fact may increase the morbidity associated with surgery.

The benefits from an extended lymph node dissection, total gastrectomy for tumors of the antrum or body of the stomach, and prophylactic splenectomy are being investigated. The initial stomach surgery approach often will be a diganostic/stagin laparoscopic procedure to evaluate the primary tumor, obtain tissue for pathologic diagnosis, and detect metastic tumor deposits. Laproscopy stomach surgery also spares patients with unresectable or metastic disease an unnecessary larger operation with extended recovery time, expediting their entry into adjuvant therapy.

At the time of stomach surgery, those patients with stage I or stage II disease then advance to an exploratory laparotomy and open surgical procedure to examine the stomach and regional lymph nodes, and to evaluate for evidence of extragastric extension of tumor or metastasis.