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The Sidney Kimmel Comprehensive Cancer Center

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Gastric Cancer Surgery

Surgery is the most common component of treatment plans for gastric (stomach) cancer and is usually recommended for most patients at some point during their treatment. One of several surgical procedures may be recommended as part of the treatment plan. Surgery may be advised in combination with chemotherapy and radiation therapy. The surgical procedures, called gastrectomies, involve removing a portion or all of the stomach where the cancer is present in order to remove the tumor(s).

Lymph Node Removal During Gastric Cancer Surgery

Studies have found a correlation between surgical success and the total number of lymph nodes the surgeon is able to remove. The medical standard in the United States is the extraction of 15 lymph nodes. Our surgeons consistently exceed that number for more accurate staging.

Removing as many lymph nodes as possible reduces the potential for the cancer to spread. It also provides a larger search area for pathologists to review to ensure the complete extraction of the cancer.   

A skilled surgeon with experience operating on stomach cancer is required to safely and effectively perform the gastrectomy and excision of the lymph nodes. Studies have shown that results are far more favorable when both the surgeon and the hospital have a large gastrointestinal program, such as the one at Johns Hopkins, in which physicians are afforded the opportunity to diagnose and treat many patients with varying types, stages and locations of gastric cancer.

Types of Procedures Used to Treat Gastric Cancer

The type of cancer, location, prognosis, size of tumor and whether the tumor has metastasized (spread to other organs) will determine the surgical approach, which may include:

Endoscopic mucosal resection:

This procedure can be used to treat pre-invasive gastric cancers and highly selected, very early stage small gastric cancers that have not spread beyond the stomach lining and which pose limited potential for metastasis to the lymph nodes. This technique allows for multiple methods for addressing the localized tumor that all utilize either dissection or ablation with chemicals, heat, electricity or a laser. 

Partial (distal) gastrectomy:

This procedure is used to treat cancers present in the distal (lower portion) stomach. It involves the removal of the lower two-thirds of the stomach along with the adjacent fatty tissue and lymph nodes. The surgeon then attaches the remaining part of the stomach to the intestine.

Total gastrectomy:

This procedure is used to treat cancers present in the middle or upper stomach or that have spread throughout the organ. The entire stomach is removed, and the esophagus is directly connected to the small intestine. In a reconstructive procedure called Roux-en-Y, a small pouch, which serves as a stomach, is created at the connection.