A gastrectomy is the removal of part (subtotal) or all (total) of the stomach. In cancer it includes a D2 lymphadenectomy and reconstruction of digestive continuity. It is now performed chiefly laparoscopically/robotically, with an open approach in selected cases.
What is a gastrectomy?
It is the resection of part (subtotal) or all (total) of the stomach with restoration of digestive continuity. The main indication is gastric cancer, where the operation follows oncological principles.
Decisive is a D2 lymphadenectomy — systematic removal of the regional lymph nodes — the established standard for oncological adequacy.
When is it needed?
The main indication is gastric cancer; also selected GISTs and, less often, complicated benign disease. The extent (subtotal vs total) is determined by tumour location and type.
The decision, the sequencing with (perioperative) chemotherapy and the strategy are made at a multidisciplinary team after full staging.
Preparation
It is preceded by endoscopy with biopsy, CT staging, often endoscopic ultrasound and, if peritoneal disease is suspected, diagnostic laparoscopy. Nutritional support and optimisation before surgery are important.
How it's done
The operation is now performed chiefly laparoscopically/robotically, with an open approach in selected cases. The affected part is removed with adequate margins and a systematic D2 lymphadenectomy is performed.
Continuity is restored with a reconstruction (often Roux-en-Y after total gastrectomy), with attention to the safety and perfusion of the anastomoses.
Subtotal
Removal of the affected part preserving some stomach — for suitably located tumours.
Total
Removal of the whole stomach with Roux-en-Y reconstruction — for diffuse or central disease.
Lap./Robotic
Now the standard approach, with oncological adequacy and faster recovery; open in selected cases.
Recovery
Eating resumes gradually with an ERAS protocol and hospital stay is usually several days. Small, frequent meals are advised; after total gastrectomy, long-term vitamin B12 replacement and nutrition/iron monitoring are needed.
A transient dumping syndrome may occur and improves with dietary adjustments.
Risks & outcomes
Specific complications: anastomotic or duodenal-stump leak, bleeding, delayed gastric emptying, and long-term nutritional deficiencies/dumping. Correct technique and nutritional follow-up limit these.
Quality markers: clear margins and an adequate lymph-node count (D2). "Success" means an oncologically complete resection with a safe reconstruction.
Frequently asked questions
Can I live without a stomach?
Yes. After a total gastrectomy the digestive tract is reconstructed and patients adapt with small, frequent meals and nutritional follow-up, including B12.
What is a D2 lymphadenectomy?
It is the systematic removal of the lymph nodes around the stomach according to oncological principles, which improves the oncological outcome.
Will I need chemotherapy?
In many gastric cancers chemotherapy is given before and/or after. The decision is made at the tumour board.
Is it done laparoscopically?
Yes, now chiefly — with equivalent oncological adequacy and faster recovery. The open approach is chosen in selected cases.