Removal of the Stomach - Gastrectomy

Gastrectomy can be performed as part or bariatric or weight loss surgery, but in this article we discuss gastrectomy surgery as its own separate surgical procedure. In this context, gastrectomy surgery is usually performed in the treatment of stomach cancer or related gastrointestinal malignancy.

Fortunately it is not absolutely necessary to have a stomach; therefore a gastrectomy to treat stomach cancer is certainly worth the disadvantages in most cases. Left untreated, gastric cancer has a high mortality. It is the world's second most common cancer and is the second leading cause of cancer death worldwide.

The gastrectomy definition, strictly speaking, is the surgical removal of the stomach. The approach to gastrectomy in this context depends on the extent and type of cancer involved. The degree of tissue removal performed during a gastrectomy will vary depending on the spread of the tumor, however most surgeons agree that the safest option is to remove the entire stomach. A total gastrectomy, as this would be called, is the best approach for assuring that no more cancerous cells that exist in the stomach remain in the body.

If the stomach cancer is near the top of the stomach, then a portion of the esophagus is usually removed as well. Likewise, if the tumor extends beyond the bottom of the stomach, the first part of the small intestine will be removed as well. While removal of the esophagus does not affect digestion (it could lead to reflux disease) removal of the duodenum (the first part of the small intestine) can greatly affect the absorption of nutrients from the diet. In fact, removal or switching the duodenum is an approach in weight loss surgery. If part of the small intestine is removed during a gastrectomy, the patient must be cautioned about weight loss and vitamin deficiencies.

Unfortunately the stomach has a lot of associated lymph nodes and lymphatic drainage. This means that cancer cells from the stomach often and easily migrate away from the stomach. Thus, an important part of a gastrectomy for gastric cancer is lymph node dissection. This lymph node dissection can be limited to diagnosis-the lymph nodes are sent to a pathologist to look for cancerous cells. Alternatively the lymph nodes surrounding and draining the stomach can be done as a therapeutic arm of the gastrectomy procedure. If cancerous cells are limited to the lymph nodes that were dissected, the gastrectomy can be curative. In some cases, adjuvant chemotherapy or radiation therapy may be necessary.

Gastrectomy recovery is similar to any bowel surgery with some exceptions. If an open gastrectomy was performed, the recovery process will be a bit longer than if the gastrectomy was performed laparoscopically. This is because the size of the incision is much longer and more tissue is cut in an open gastrectomy. Since most or all of the stomach was removed, gastrectomy recovery should include information about diet. Meal size will need to be decreased dramatically since there is no place to store large amounts of swallowed food. Often people recovering from gastrectomy will be encouraged to eat numerous small meals throughout the day. In a total gastrectomy, this limitation on meal size may need to be in place for a lifetime.