Surgery is part of the standard treatment for the majority of patients with gastric cancer. However, since gastric cancer is not exclusively treated by surgery, it is important for patients to be treated at a medical center that can offer multi-modality treatment involving surgeons, medical gastroenterologists, radiation oncologists, medical oncologists and nutritionists.
Gastric cancer is the second most common cause of cancer-related death in the world, and it remains difficult to cure in Western countries, primarily because most patients present with advanced disease. In the United States, stomach malignancy is currently the 14th most common cancer. The stomach begins at the gastroesophageal junction and ends at the duodenum. See the image below.
Individuals with gastric cancer are frequently treated with surgical removal of the stomach (called a gastrectomy), to remove the cancer and prevent recurrence (or return) of the cancer. Lymph nodes (parts of the body’s lymph system) around the stomach are also removed and examined to determine whether or not the cancer has spread to these areas. Depending on the stage (extent of disease) of the cancer, the majority of patients will also be treated with chemotherapy drugs and/or radiation therapy.
A complete removal of the primary cancer and the lymphatic drainage of the cancer is the primary goal of any surgical treatment for gastric cancer. Patients with gastric cancer may have a total or partial removal of the stomach. When patients undergo a partial removal of the stomach, the remaining portion of the stomach is re-attached to the upper part of the small intestine (duodenum) or to the middle part of the small intestine (jejunum) or to the esophagus. Cure rates for gastric cancer are related to the extent of cancer at the time of diagnosis.
During a total gastrectomy, the entire stomach is removed and the two remaining ends of the gastrointestinal tract are reconnected. This is the most common operation for cancer of the upper stomach. For cancers of the middle and lower stomach, an incision is made in the abdomen and the entire operation can be carried out without entering the chest. The usual operation for cancer of the upper stomach, called the cardia, is an incision that involves entering both the abdomen and the chest. An alternative approach is a single incision in the abdomen with an incision through the diaphragm (transhiatal approach). The transhiatal approach for total gastrectomy for cancer of the upper stomach is a safe alternative to the standard thoracoabdominal technique and avoids entering the chest and the associated complications.