Surgery is an important treatment for many stomach cancers. The results of surgery have improved in the last 10 years. This is because stomach cancer is often found and treated earlier, and because of advances in surgical methods.

If the cancer is diagnosed at an early stage, an operation may be all that’s needed to cure it. This may involve removing part of the stomach (a partial gastrectomy) or all of the stomach (a total gastrectomy). Which operation is needed depends on the size of the tumour and where it is in the stomach.

Often, the lymph nodes close to the stomach are removed at the same time to see if the cancer cells have spread into them. Depending on the extent of the cancer, some other organs in the area of the stomach may be removed during the operation. These may include the lower part of the gullet (oesophagus), the upper part of the small bowel (duodenum), the spleen or part of the pancreas.

In some situations, it may be possible to have keyhole or laparoscopic surgery to remove some, or all of your stomach. In this type of surgery only small openings are made instead of one larger cut. The surgeon uses a special instrument called a laparoscope to see and work inside the tummy (abdomen).

The laparoscope is put into the abdomen through the small cuts in the skin. Generally, about three small cuts and one larger cut are needed for the operation. The larger one is used to remove the stomach.

With this type of surgery recovery time may be quicker (but this has not yet been proven in clinical trials).

The chances of curing stomach cancer appear to be as good with keyhole surgery as with bigger operations. However, it hasn’t been used for long enough to be absolutely sure of this.

Keyhole surgery should be carried out by surgeons with specialist training and experience in using laparoscopic techniques. This type of surgery isn’t widely available so, if it is suitable for you, you may need to travel to another hospital to have the operation.

Sometimes the cancer may cause a blockage, and stop food from being able to pass through the gut. If this happens, the surgeon may be able to do one of the following:

• A thin flexible tube (stent) is placed into where the blockage is to allow food to go through. The stent can be put in under a local anaesthetic using a long flexible tube (endoscope) that goes down the gullet and into the stomach.
  
• Operate to remove part of the stomach where the blockage is (partial gastrectomy).
  
• Bypass the blockage by making a new connection between two parts of the gut (gastrointestinal tract) so allowing food to get through. This is called bypass surgery.

Surgery to relieve a blockage in the stomach can often relieve symptoms but won’t cure the cancer.

Having part or all of your stomach removed involves a major operation. So, before you have this type of surgery your doctors will need to make sure that you’re physically able to cope with it and that it isn’t too risky for you. This may involve you having tests, such as heart and lung tests, to check your general health and fitness. If you have been having problems with eating and have lost weight you may be given extra help and support with your diet to help prepare you for the operation.

On the day of your operation

You will have fasted overnight and won’t have anything to eat until after the operation. You will have a bath or a shower and you will be given a hospital gown to change into. You may also be given special support stockings to wear. These are to help prevent blood clots developing in your legs during or after the operation.

You may be nursed in the intensive care or high-dependency unit immediately after your operation. This is routine in many hospitals and doesn’t mean your operation has gone badly or that there are complications.

You will probably have an oxygen mask on to start with to help you breathe more easily. For the first few hours after the operation a machine, called a ventilator may be used to help you with breathing.

The nurses will encourage you to start moving about as soon as possible after your operation. This is an essential part of your recovery, as it helps to prevent problems such as chest infections or blood clots from developing. If you have to stay in bed, the nurses will encourage you to do regular leg movements and deep breathing exercises. A nurse or a physiotherapist can help you to do the exercises.

Drips and drains

After the operation you may have some of the following in place for a short time:

• A fluid drip going into your vein (intravenous infusion). This  will give you fluids until you are able to eat and drink again. It may also be used to give you painkillers.
  
• A fine tube going into your back (epidural). This may be used to give you drugs that numb the nerves and stop you feeling sore.
  
• A naso-gastric (NG) tube. This is a tube that passes down your nose into your stomach or small bowel and allows fluids to be removed so that you don't feel sick. It’s usually taken out within 48 hours.
  
• A feeding tube that goes into the small bowel through a small cut in the abdomen. It is used to give you food and nutrients until you are able to begin eating again.
  
• A small flexible tube (urinary catheter) to drain urine from your badder into a collecting bag. This is usually taken out after 48 hours.
  
• A drainage tube coming from your wound. This helps to prevent swelling and allows the wound to heal properly. It is taken out after a few days.

Drinking and eating

After an operation to remove part or all of your stomach, new joins are made in your gut. These joins will need a few days to heal. So, you won’t be able to eat and drink immediately after your operation.

You may have a feeding tube in place for a few days. This will be used to give you food until you are able to eat. The surgeon puts this in during surgery. It is put into the middle part of the small bowel (the jejunum) through a small cut made in the wall of the tummy (abdomen). It will be taken out soon after you have begun to eat again.

After about 48 hours you will probably be ready to start taking small sips of water. This will be gradually increased until you are able to eat a light diet, usually four or five days after your operation. Before you start eating again you may have a test in the x-ray department, called a barium swallow. This involves drinking a chalky liquid (barium) that shows up on x-rays. The test is done to check that the joins in your gut are healing properly.

Pain

After your operation you’ll need painkilling drugs for a few days. These may be given into a vein (intravenously), into the space around your spinal cord (epidural), into a muscle (intramuscularly) or as tablets.

To begin with you may be given intravenous painkilling drugs through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller. You may also have a hand control with a button you can press if you feel sore. This is called patient controlled analgesia (PCA). It is designed so that you can’t have too much painkiller (overdose), so it’s okay to press it whenever you are uncomfortable.

Some people have painkilling drugs given into the space around the spinal cord (epidural). The drugs numb the nerves and are often given through a syringe and tubing attached to an electronic pump.

If you are in pain, let your nurses and doctors know as soon as possible. This will help them to give you the combination and dose of painkillers that is right for you.

Going home

You will probably be ready to go home about 7–14 days after your operation.  If you think you might have problems when you go home – for example, if you live alone or have several flights of stairs to climb – let the nurses or social worker know when you go into hospital, so that help can be arranged when you go home.

You’ll still be recovering for sometime after you go home and will need to take things easy for several weeks. It is best to gradually build up your level of activity. It will probably take between three to six months before you are fit enough to go back to work.

Provided you feel comfortable to do so it’s usually fine to begin driving again from four to six weeks after your operation. In general, if you feel well enough, it’s safe to have sex again from about four weeks or so after the operation. But, this will be much too early for some people and it depends on how you feel.
Some people take longer than others to recover from their operation. If you’re having any problems you may find it helpful to talk to someone who is not directly involved with your illness.

The nurses at Cancerbackup are always happy to talk with you. They can also give you details of support groups in your area, where you can talk to other people who have had similar problems. You can contact the Cancer Counselling Trust to talk to a counsellor.

Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic. This will be a good time to talk to your doctor about any problems you may have after your operation.