For the most part, gastrectomy for stomach or gastric cancer is an essential step in the cancer treatment process. In other cases, this stomach removal surgery may be necessary and recommended when patients have a CDH1 genetic mutation that highly increases the risk of developing the disease. No matter the underlying cause, the main aim of gastrectomy is to eliminate the disease or the risk of developing it.
In the following blog post, Dr. Omar Rashid with his experienced team will share their knowledge regarding stomach cancer and gastrectomy, discuss different intervention types, touch base on the essentials of stomach cancer, and more.
What is Stomach Cancer?
In the case of stomach or gastric cancer, mutated malignant cells grow out of control in the stomach tissue. The malignancy may develop anywhere in the stomach. Still, in the United States, most stomach cancer cases involve the formation of abnormal cells in the gastroesophageal junction or where the esophagus and the stomach meet. In other countries, on the other hand, abnormal cell growth will mainly appear in the stomach’s main part.
In around 95% of cases, gastric cancer develops in the stomach lining and grows rather slowly. If untreated, it can form a more massive tumor which may protrude deeper into the stomach walls. Furthermore, the mutated cells may spread to organs nearby, like the pancreas and liver.
Which individuals are susceptible to stomach cancer? Stomach cancer can affect anyone, but specific demographic characteristics can heighten the risk. If you fall into any of the following categories, you are more likely to develop stomach cancer:
- If you are 65 years old or older.
- If you were assigned male at birth.
- If your ethnic background is East Asian, South or Central American, or Eastern European
Furthermore, gastric cancer is among the most common malignancies worldwide. Still, it’s one of the less common cancers in the US, as only around one and a half percent of cases get diagnosed in the country, with a declining number of cases in the last decade.
Gastrectomy: What is It?
As mentioned above, gastrectomy or stomach removal surgery is a medical intervention that removes either part of the entire stomach. Undergoing gastrectomy will change how patients eat because the body will digest food differently after the intervention.
In some stomach cancer cases, the smaller gastric tumors that have yet to undergo metastasis (have not spread yet) may be treated with stomach removal surgery alone. Unfortunately, in more advanced cases, more extensive cancer treatments may be required, which will include a combination of surgery and other cancer treatment options such as radiation and/or chemotherapy.
Typically, there are two different types of gastrectomy surgeries healthcare providers perform: subtotal gastrectomy (partial stomach removal) or total gastrectomy. The extent (stage) of the malignancy and the tumor’s location will play a crucial role in determining the type of gastrectomy surgeons will recommend to cancer patients.
Also, some people may opt for prophylactic gastrectomy, which is a subcategory of total gastrectomy usually performed when patients have the above-mentioned CDH1 genetic mutation.
About Subtotal and Total Stomach Removal Surgery
Below are the different types of interventions experts will usually perform after the patient has received a stomach cancer diagnosis.
Diagnostic Laparoscopy
When the patient has been diagnosed with gastric cancer that has already started to spread, they may receive neoadjuvant chemotherapy before surgery to make the tumor smaller. Shrinking the tumor can greatly increase the chances of successful removal.
Still, before providers can administer these chemo treatments, patients need to undergo staging or diagnostic laparoscopy, during which:
- Surgeons insert a tube with a camera into the abdomen via a small incision.
- They will examine the stomach, the abdominal lining, and the abdominal cavity
- They will take different tissue samples to check for the presence of cancer in other structures besides the stomach.
Diagnostic laparoscopy can help with staging stomach cancer as it can help determine the state of metastasis. This is a minimally invasive procedure that can only aid in the treatment plan, ensuring a better chance for a good outcome.
Partial or Subtotal Gastrectomy
A subtotal distal gastrectomy is a surgical procedure that involves the removal of a portion of the stomach. Medical professionals usually perform this procedure when there is stomach cancer located in the lower part of the stomach, known as the distal stomach. The extent of the stomach removal depends on the tumor’s location. During a subtotal distal gastrectomy, the surgeon:
- Divides the stomach into two sections.
- Removes the lower half of the stomach, including the tumor and nearby lymph nodes.
- Sends the lymph nodes to a pathologist for examination to determine if the cancer has spread.
- Reconstructs the gastrointestinal tract by connecting a loop of the intestine to the stomach, creating a new pathway for food digestion. Most patients undergo open surgery for a subtotal distal gastrectomy under general anesthesia. However, some individuals may qualify for a laparoscopic-assisted procedure, which involves smaller incisions and often leads to a quicker recovery.
Total Gastrectomy
A total gastrectomy means that the entire stomach will be removed. After stomach removal surgery, the medical expert will attach the esophagus to the small intestine, creating a new connection for the food to pass through the GI tract.
In most cases, experts perform total gastrectomy when the malignancy is in the proximal stomach (the organ’s upper portion). During surgery, professionals divide the upper part of the stomach and the esophagus to remove the organ. In some cases, they may only remove the proximal stomach.
In the majority of cases, patients undergo total gastrectomy in the form of open surgery under general anesthesia. In other cases, the intervention may be performed as a laparoscopic-assisted, less invasive procedure.
Prophylactic Gastrectomy
Prophylactic gastrectomy, also known as preventive or risk-mitigating total gastrectomy, is recommended for individuals with the CDH1 gene mutation. This mutation is associated with a high risk (50 to 80 percent) of developing stomach cancer, which tends to metastasize more easily. If you have this gene mutation, undergoing a prophylactic gastrectomy is a significant decision to consider.
Most patients undergoing this procedure are in good health at the time of surgery. However, it’s important to note that gastrectomy brings about substantial lifestyle changes, particularly in terms of dietary habits and restrictions.
To assist you in making an informed decision that suits your specific circumstances, we offer multiple consultations during which we provide detailed explanations of what you can anticipate. Additionally, we can connect you with other patients who have undergone prophylactic gastrectomy so that you can gain insight from their experiences.
Learn More
Naturally, patients will receive the necessary information and instructions regarding preparation and everything it may include, from exercise to diet and more. Following the surgery, their recovery will be closely monitored, and beforehand, patients will receive detailed guidelines about the changes they will have to get used after surgery.
To learn more about these changes and to receive more info about stomach removal surgery in general, please, schedule an appointment with us today. Dr. Omar Rashid and his expert staff are always ready to help at our practice.