A gastrectomy is the complete removal of the stomach. This is to be distinguished from (subtotal) gastric resection, in which only part of the stomach is removed. Today, total gastrectomy is used almost exclusively for malignant gastric tumors (stomach cancer). Here you will find further information as well as selected gastrectomy specialists and centers.
A gastrectomy is the total = complete removal of the stomach. This is to be distinguished from (subtotal) gastric resection, in which only part of the stomach is removed. Today, total gastrectomy is used almost exclusively for malignant gastric tumors(stomach cancer).
It is not necessary to remove all or part of the stomach in all cases of gastric cancer. Under certain circumstances, tumors can be removed using minimally invasive gastroscopy. To do this, the stomach tumor must
In all other cases, gastric surgery is the only possible cure for this disease.
Tumor staging is required before a treatment decision can be made. This involves assessing the local spread and possible metastasis (= spread into the body) of the carcinoma. On this basis, the tumor can be classified into a stage.
This is initially done by means of gastroscopy, during which the stomach can be assessed and the local extent of the carcinoma can be visualized. Tissue samples can also be taken. If it turns out to be a so-called "low-risk tumor", it can also be removed during the gastroscopy. Ideally, no further operations are necessary afterwards. However, this is only possible at a very early stage of the tumor.
Other imaging procedures such as ultrasound and computer tomography provide additional information.
Depending on the findings of these examinations, there are several treatment options:
For "low-risk tumors" at an early stage, removal of the tumor by gastroscopy may be possible.
The location of the stomach and the (not to scale) representation of stomach cancer © peterschreiber.media | AdobeStock
Primary surgery is indicated if
Neoadjuvant therapy, i.e. radio-chemotherapy prior to surgery, is indicated if
Palliative therapy is indicated for
Gastric tumors that have already affected other neighboring organs and have become very large are not medically curable. In addition, tumors that have formed distant metastases are often no longer curable. Metastases can develop in the liver or abdomen, for example. Nevertheless, such tumors can be treated in order to prolong life and improve quality of life. This is referred to as palliative therapy.
In these cases, drug-based tumor therapy is usually indicated to curb the growth of cancer cells and treat pain. However, surgery is only performed in cases where the tumor is obstructing the stomach outlet. The purpose of this operation is to improve the quality of life by maintaining the passage of food, but not to remove the tumor tissue.
Based on the tumor location and the type of tumor cell differentiation(Laurén classification), doctors decide whether
has the best chances of recovery.
With the so-called intestinal type according to Laurén, an upward safety margin of 5 cm is sufficient. This means that when the tumor is removed, the tissue 5 cm around the tumor is also removed.
In the case of tumors in the lower third of the stomach, a stomach remnant can therefore be left behind. For tumors located further up in the stomach, a complete gastrectomy is required.
A complete gastrectomy is
is almost always necessary.
In principle, surgery for stomach cancer can be performed open or via laparoscopy(laparoscopy).
However, the equivalence of laparoscopic gastric resection, which is also referred to as minimally invasive, with the open approach has not yet been established. Most clinics therefore operate on gastric carcinoma using the open technique.
However, if the minimally invasive approach is chosen, care must be taken to ensure that the operation is performed with the same radicality.
Illustration of a gastroscopy © bilderzwerg | AdobeStock
Tumor metastases in the abdominal cavity (peritoneal carcinomatosis) must first be excluded by means of laparoscopy. Otherwise, the gastric tumor cannot be cured by the operation and it would have to be cancelled.
During the operation, either a transverse opening of the abdominal cavity or access via a longitudinal incision is made. The duodenum is then cut through just behind the pylorus and all lymph nodes are located and removed.
The extent of the lymph node removal is decisive for the patient's prognosis. The removal of the lymph nodes (lymphadenectomy) therefore requires the utmost attention.
The lymph nodes around the liver, pancreas, spleen and abdominal aorta are particularly important. They must be carefully located and removed. The capsule of the pancreas is also removed during this dissection.
Removal of the spleen itself is now only recommended for very extensive tumors. This can be particularly useful for tumors located along the large gastric curvature and the stomach entrance area.
After cutting the left gastric artery, the dissection continues along the abdominal aorta and the diaphragmatic legs up to the diaphragmatic hiatus. In this way, the short gastric arteries, which connect to the splenic artery, are also severed.
The stomach is now attached exclusively to the esophagus and is deposited here. After transection of the esophagus with frozen section histological verification of the absence of tumor in the area of the resection line, the intestinal continuity is reconstructed.
The bowel must remain functional despite the (partial) removal of the stomach. This is referred to as intestinal continuity. There are two main options for this:
There are no significant differences in the quality of life after the two different reconstruction methods. Further modifications in the restoration of esophageal-gut continuity are various forms of replacement stomach formation, the value of which is assessed differently.
In a Roux-en-Y gastrectomy, the intestine is attached to the upper part of the stomach © crevis | AdobeStock
Modern hemostasis procedures and dissection techniques are very advanced today. It is therefore not absolutely necessary to administer blood during or even after the operation. Nevertheless, bleeding can occur during the operation, e.g. in the event of injury to large vessels, or after the operation. In such cases, a repeat operation often has to be performed to locate the source of the bleeding and stop it.
However, the most feared complication after a gastrectomy is so-called anastomotic insufficiency. This refers to a leak in the suture in the area of the connection between the oesophagus and small intestine. Treatment of this leak (also known medically as leakage) can often be conservative, but sometimes leads to the need for a repeat operation.
Other possible complications are
With all reconstructive procedures, the patient can no longer eat large amounts of food at a time after the operation. Instead, they must eat smaller portions several times a day.
The only food component that can no longer be absorbed after a complete gastrectomy is vitamin B12. This requires regular supplementation by injection every 8-12 weeks. If diarrhea occurs, a supplement of pancreatic enzymes may be useful.
Many patients lose weight for about ½ year after a complete gastrectomy. After that, the body gets used to the new situation. During this time, the weight loss can be counteracted by drinking nutritional solutions. These can be used to provide easily digestible and high-calorie food without putting too much strain on the digestive tract. However, the quantity is also limited here, and excessive intake can lead to nausea, vomiting and diarrhea.
Overall, the 5-year survival rates for gastric cancer are very stage-dependent.
For example, the chance of recovery for a carcinoma that is only limited to the mucous membrane of the stomach is well over 90 %.
In contrast, the 5-year survival rate for advanced gastric carcinoma is between 30 and 40 %. Of particular importance here is the ratio of the number of lymph nodes removed to the number of affected lymph nodes.
Close tumor follow-up is not advisable for gastric carcinoma, as there are only very limited treatment options if metastases occur. For this reason, so-called symptom-oriented follow-up care is favored.
Nevertheless, regular blood and ultrasound examinations should be carried out. Regular visits to the family doctor can also provide timely relief with regard to nutritional disorders, which often occur in the initial period after gastrectomy. In some cases, substitution, as a targeted replacement of nutrients and vitamins, is necessary and can restore quality of life.
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