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. In selected cases it is done laparoscopically/robotically.
What is a gastrectomy?
It is the surgical removal of the stomach, partial (usually the lower part) or total. In cancer it is accompanied by a lymphadenectomy and reconstruction of the digestive tract.
When is it needed?
The main indication is gastric cancer. It is also indicated for large or complicated GISTs and selected benign conditions not otherwise treatable.
Preparation
Full staging (endoscopy, EUS, CT, often diagnostic laparoscopy) and a decision at a tumour board are required. Important is nutritional support before and after.
How it's done
The affected part of the stomach is removed together with the corresponding lymph nodes (D2). Digestive continuity is restored with an anastomosis (e.g. Roux-en-Y). In selected patients the operation is done minimally invasively.
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
In selected patients, with oncological adequacy and faster recovery.
Recovery
Hospital stay lasts several days, with a gradual reintroduction of eating and small, frequent meals. After a total gastrectomy, vitamin B12 supplementation and nutritional follow-up are needed.
Risks & outcomes
A major operation with very good oncological outcomes in specialist hands. Possible complications: anastomotic leak, infection, nutritional disturbances (dumping syndrome, B12 deficiency).
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?
In selected patients, yes — with equivalent oncological adequacy and faster recovery.