Stomach cancer is one of the most common cancers in Germany. Stomach cancer is the 6th most common cancer in men and the 5th most common cancer in women each year. In terms of deaths, it is the fourth most common fatal cancer in both men and women.
There are around 18,500 new cases of colorectal cancer in Germany each year, which corresponds to around half of all new colorectal cancer patients.
The average age of onset is 68 for men and 74 for women.
Stomach cancer is a common form of cancer © peterschreiber.media | AdobeStock
Surgical removal of the tumor is the most important part of stomach cancer treatment. Gastric tumors cannot be cured by chemotherapy and radiation. Therefore, stomach cancer surgery is the only chance of a complete cure.
As with other cancer operations, two different methods are available for this: open and minimally invasive gastric cancer surgery.
Open stomach cancer surgery
In principle, the old method using a large incision in the upper abdomen ("open surgery") has been available for many years. The surgeon opens the abdominal cavity and operates directly on the tumor with his hands and various instruments.
Open gastric cancer surgery allows the surgeon to gain a good overview and feel the exact extent of the tumor.
Minimally invasive stomach cancer surgery
The newer minimally invasive surgical technique, also known as laparoscopy, requires only a few very small incisions. A camera lens and tiny instruments are inserted into the abdomen through these incisions. The surgeon sees the inside of the abdomen live on a monitor and therefore works without direct vision.
The minimally invasive procedure requires the surgeon to have special experience. It is more expensive than open stomach cancer surgery due to the use of various disposable instruments.
There is no difference between the two techniques in terms of intraoperative complications and blood loss. Laparoscopic gastric cancer surgery generally takes slightly longer than open gastric cancer surgery. On the other hand, it requires less manpower.
Recovery after laparoscopic surgery is somewhat faster than with open surgery due to less pain. The aesthetic result of laparoscopic surgery is also superior to that of open surgery.
The occurrence of adhesions or incisional hernias is lower after laparoscopic surgery. In terms of healing and the occurrence of postoperative complications, both surgical techniques are comparable.
In Germany, only very few gastric cancer operations are performed minimally invasively (2.5%). However, a few centers have a great deal of experience in this special surgical technique.
Whether minimally invasive or open, curative gastric cancer surgery involves the removal of the stomach. In some cases, partial removal is sufficient. In this case, a large part of the stomach is removed together with the section affected by the tumor and the lymphatic drainage area in one package (en-bloc resection).
Gastrectomy with D2 lymphadenectomy
Removal of the entire stomach with the lymph nodes of the 1st and 2nd compartments is the standard operation for gastric cancer. It does not matter whether the gastric cancer surgery is performed open or laparoscopically.
In the case of large tumors, the removal of neighboring organs such as
- the spleen
- the transverse colon or
- of parts of the diaphragm
may be necessary for complete tumor removal.
After removal of the stomach, the food passage must be restored. Various procedures are available for this purpose, with and without the formation of a replacement stomach. They produce similar results over time.
The most common is reconstruction using a jejunoesophagostomy according to Roux-Y. It is particularly important to ensure that the distance between the upper and lower anastomosis is between 40 and 60 cm.
Illustration of Roux-Y reconstruction © bilderzwerg | AdobeStock
Partial gastric resection with D2 lymphadenectomy
In suitable cases, a 2/3 or 4/5 gastric resection is possible if the tumor is located at the gastric outlet. In this case, the food passage is restored according to Roux-Y.
Palliative operations
It is not always possible to remove the gastric tumor completely. In this case, a direct connection between the stomach and upper small intestine may be necessary to restore the possibility of food intake while leaving the stomach tumor intact.
As with any operation, the procedure involves risks and dangers. Pre-existing concomitant diseases of the heart or lungs can increase the risk of surgery. It is important to check in advance what measures are available to reduce the risk of surgery.
As there is no alternative to stomach cancer surgery, it may be necessary to check whether limiting the surgical procedure will still allow the tumor to be completely removed.
Complications can also occur that can endanger the patient's health and prolong the hospital stay.
The following complications are possible after stomach cancer surgery
Bleeding: The risk of relevant secondary bleeding is very low at 1% thanks to modern vessel sealing techniques. The main risk of secondary bleeding is therefore within the first 24 hours after gastric cancer surgery.
Anastomotic ins ufficiency: A leak in the suture between 2 intestinal ends and, in the case of gastric cancer surgery, also between the oesophagus and intestine or stomach remnant and intestine is referred to as anastomotic insufficiency. There is a risk of this up to the 7th postoperative day.
The reason for this is usually reduced blood flow in the area of the new connection (anastomosis). There is an increased risk with concomitant diseases such as
However, the overall rate should be below 5% in experienced clinics.
Left: Healthy blood vessels. Right: Blood vessels with arteriosclerosis. There is a higher risk of complications with arteriosclerosis © Axel Kock | AdobeStock
Wound infections: Wound infections occur in up to 2% of patients after open gastric cancer surgery. These are usually harmless, but can prolong the hospital stay and lead to an incisional hernia later on.
Pain: Pain after stomach cancer surgery can vary greatly from patient to patient. It also depends on the access trauma in the abdominal wall (open or minimally invasive surgery).
The aim is to keep the patient pain-free. Faster mobilization (physiotherapy and respiratory gymnastics) is then possible. This reduces the rate of general complications such as pneumonia and thrombosis.
A special form of painkiller administration via a catheter close to the spinal cord (PDK) can be very helpful here.
Stomach cancer surgery can cause problems for those affected in the initial period after the operation. These mainly relate to nutrition. Due to the shortening or absence of the stomach passage, the chyme is transported too quickly into the small intestine. As a result, the body cannot fully utilize the nutrients.
Patients require the replacement of various vitamins and trace elements, especially after complete gastric resection. Diarrhea caused by fat digestion disorders can be improved by fat-splitting enzymes. The best way for patients to counteract the weight loss that almost always occurs after stomach cancer surgery is to eat a diet rich in carbohydrates and protein.
The rapid absorption of food into the small intestine can also lead to so-called dumping syndrome. This leads immediately or after a delay of a few hours to
- Circulatory problems,
- nausea,
- sweating,
- palpitations,
- dizziness and
- drop in blood pressure.
The cause lies in the strain on the intestines and the resulting metabolic disorders. The best way to combat these problems is to spread the food over six to ten smaller meals. You should also avoid drinking immediately after meals. A special diet is not necessary.
After stomach cancer surgery, you should eat several small meals throughout the day © Gresei | AdobeStock
The removal of the stomach or part of it means that the stomach pylorus and the lower esophageal sphincter are missing. This sometimes causes food particles and digestive secretions to flow back into the oesophagus.
These symptoms can be reduced by eating in an upright position. Patients should also refrain from eating for some time before going to bed. Otherwise, there is a risk that stomach contents may repeatedly enter the lungs when lying down and lead to pneumonia.
As with other cancers, aftercare following stomach cancer surgery follows a precisely defined schedule. It consists of regular clinical examinations with
With timely diagnosis and surgery, a cure is possible depending on the stage of the tumor.
The 5-year survival rate is 27% for men and 28% for women. Cancer of the stomach leads to an average loss of life expectancy of 8 years for men and 9 years for women.
