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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on May 21, 2021.

Gastrectomy

A gastrectomy is a surgical procedure to remove all or part of the stomach. This procedure may be performed as part of weight-loss surgery or to treat ulcer disease or stomach cancer.

When a gastrectomy is performed to treat stomach cancer—also called gastric cancer—two procedures are commonly used:

  • Total gastrectomy, which removes the entire stomach
  • Subtotal gastrectomy, which removes the part of the stomach that has cancer

Other than cancer that’s spread to other parts of the body (stage IV), all other stages of gastric cancer may be treated with either total or subtotal gastrectomy.

Surgeons try to leave as much of the stomach as possible. However, the main goal is to remove all the cancer, without any cancer cells being left at the edges (margins). The choice of procedure depends on where the cancer is in the stomach and how far it’s grown.

Before the procedure

Before surgery, you may undergo a complete history and physical exam to make sure you’re healthy enough for the procedure. This may include blood tests as well as tests of the heart and lung functions. Because stomach cancer patients may be undernourished or underweight, a nutritional exam may be done to see whether supplements are needed before or after surgery.

You may be asked to stop taking medications that thin your blood and increase the risk of bleeding. You should ask the surgeon whether you may take your normal medications with a sip of water on the day of surgery. Because this procedure is performed under general anesthesia, you may need to follow instructions about when to stop eating and drinking.

During the procedure

  • Gastrectomy procedures may be done with one long incision through the belly—this is called open gastrectomy.
  • In some cases, a gastrectomy may be done through small incisions, using an operating scope and other surgical instruments that fit through the incisions. The scope has a camera that sends images to a video screen in the operating room. This is called a laparoscopic gastrectomy.

If you’re having a total gastrectomy, the surgeon may remove all of your stomach and nearby lymph nodes. The stomach may be separated from the esophagus and from the small intestine underneath. A flap of tissue that lies over the stomach, called omentum, may also be removed. If cancer has spread to nearby tissues above or below the stomach, these tissues may be removed. If cancer has reached the spleen, it is also removed. After your surgeon removes all the cancer and involved tissues, the end of the esophagus is attached to the end of the small intestine to create a new intestinal passage.

If you’re having a subtotal gastrectomy, either the upper or lower part of the stomach is removed.

  • If cancer is in the upper stomach, it’s called a proximal gastrectomy.
  • If cancer is in the lower part, it’s called a distal gastrectomy.

Part of the omentum is removed, along with nearby lymph nodes. Nearby tissues may be removed if cancer has spread there. The remaining part of the stomach is then attached either to the esophagus or small intestine.

After the procedure

You may be in the hospital for a week or more after a gastrectomy. For the first two days, you may need a tube inserted through the nose and into your stomach area to drain fluids. Until you’re able to eat and drink, you may receive fluids and nutrition through an intravenous (IV) line. You should be able to start a light diet after the first week.

Pain is normal after a gastrectomy, and your care team may prescribe pain medication. It may take several weeks to return to full activities.

Diet is an important part of recovery. Because your stomach is smaller or removed, you may have to eat differently. Working with a dietitian may help ensure you’re getting proper nutrients and enough calories. It’s common to need diet supplements.

You also should watch out for complications. Call your surgeon if you have:

  • Fever
  • Cough
  • Diarrhea
  • Heartburn
  • Redness, swelling, pain or discharge at the incision areas
  • Shortness of breath or difficulty breathing
  • Pain, swelling or redness in the calf area

What are the risks of a gastrectomy?

A gastrectomy is a major type of surgery, and complications are possible. It’s very rare for anyone to die from complications of this surgery, but some risks include bleeding, blood clots and damage to nearby organs. Less commonly, the area where the cut ends of the organs are reconnected (an anastomosis) may not close properly. This may cause leaking of digestive juices or foods and liquids.

Below are other side effects and complications that may happen during or after surgery.

  • Infection: An infection in the surgical incision area is a rare complication that may require antibiotics or drainage.
  • Fullness: Because your stomach may be smaller or removed, you may feel full soon after eating. Although the remaining tissues stretch over time, you may need to eat small meals every few hours for a while.
  • Lung problems: Surgery may cause you to avoid coughing and deep breathing. That may lead to loss of air in your lungs (atelectasis) or infection (pneumonia).
  • Diarrhea: Because food may move more quickly through your upper digestive system after surgery, you may have a type of diarrhea called dumping syndrome.
  • Weight loss: Fullness and dumping syndrome may lead to difficulty getting enough calories to maintain weight.
  • Vitamin B12 deficiency: Because stomach cells help absorb vitamin B12, levels of this vitamin may get low and lead to anemia. You may need vitamin B12 injections.
  • Pulmonary embolism: Blood clots that form in the legs may break loose and travel to the lungs, causing chest pain and difficulty breathing. Blood-thinning medications, compression stockings and frequent walking may help prevent those complications.
  • Stricture: An anastomosis may leave scarring that narrows the esophagus and causes painful or difficult food passage.
  • Heartburn: A gastrectomy may make it easier for stomach acid to seep up into the swallowing tube (esophagus), causing heartburn. This side effect may be treated with antacids.

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