Surgery is an important treatment for many stomach cancers. The results of surgery have improved in the last ten years, because nowadays the cancer is often found and treated earlier, and because better surgical methods have been developed.
If the cancer is diagnosed at an early stage, a surgical operation may be all that is needed to cure it. This usually involves removing only a part of the stomach (a partial gastrectomy).
If all of the stomach is removed this is known as a total gastrectomy (see diagram below).
Often, the lymph nodes close to the stomach are removed at the same time to see if the cancer cells have spread into them. Depending on the extent of the cancer, some other organs in the area of the stomach may be removed during the operation. These may include the lower part of the gullet (oesophagus), the upper part of the small bowel (duodenum), the spleen or part of the pancreas.
If the lower part of the gullet has been removed the gullet is reconnected directly to the small intestine.
Occasionally, before the surgeon decides to operate on your stomach, they may pass a small tube with a light at the end, through a cut in the wall of your abdomen. This is known as a laparoscopy. This is to help decide whether to remove all or part of the stomach. The laparoscopy is done under general anaesthetic and the area will feel sore for a few days afterwards.
Sometimes the cancer may block the passage of food from the stomach to the bowel. If this happens, the surgeon may make a connection between the stomach and the small intestine to allow food to bypass the blockage. This is known as bypass surgery and will not cure the cancer, but can relieve symptoms.
After your operation
After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.
Drips and drains
A drip (intravenous infusion) will be used to maintain the body's fluids until you are able to eat and drink again.
You will also have a naso-gastric (NG) tube in place. This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don't feel sick. It is usually taken out within 48 hours.
Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag. You may also have a drainage tube in your wound for a few days to make sure that the wound heals properly.
Drinking and eating
After an anaesthetic, the movement of the bowel slows down, so it is important that you only drink small amounts until it is back to normal. After about 48 hours you will probably be ready to start taking small sips of water. This will be gradually increased after a couple of days until you are able to eat a light diet, usually four or five days after your operation.
After your operation you may need to take painkilling drugs for a few days. These are usually very effective in controlling any pain. If you still have pain, it is important to let the ward nurses know as soon as possible. Your painkillers can be changed until you find a type and dose that is effective.
You will probably be ready to go home about two weeks after your operation, once your stitches have been removed. If you think you might have problems when you go home – for example, if you live alone or have several flights of stairs to climb – let the nurses or social worker know when you go into hospital, so that help can be arranged when you go home.
Some people take longer than others to recover from their operation. If you are having any problems you may find it helpful to talk to someone who is not directly involved with your illness.
Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic. This is a good time to talk to your doctor about any problems you may have after your operation.