Removal of the tumor, often with removal of surrounding lymph nodes, is the only curative treatment for various forms of gastric (stomach) cancer. For many patients, this entails removing not just the tumor but part of the stomach as well. The extent to which lymph nodes should also be removed is a subject of some debate, but some studies show additional survival benefit associated with removal of a greater number of lymph nodes.
Gastrectomy, either total or subtotal (also called partial), is the treatment of choice for gastric adenocarcinomas, primary gastric lymphomas (originating in the stomach), and the rare leiomyosarcomas (also called gastric sarcomas). Adenocarcinomas are by far the most common form of stomach cancer and are less curable than the relatively uncommon lymphomas, for which gastrectomy offers good odds for survival.
After gastrectomy, the surgeon may "reconstruct" the altered portions of the digestive tract so that it continues to function. Several different surgical techniques are used, but, generally speaking, the surgeon attaches any remaining portion of the stomach to the small intestine.
Gastrectomy for gastric cancer is almost always done by the traditional "open" surgery technique, which requires a wide incision to open the abdomen. However, some surgeons use a laparoscopic technique that requires only a small incision. The laparoscope is connected to a
tiny video camera that projects a picture of the abdominal contents onto a monitor for the surgeon's viewing. The stomach is operated on through this incision.
The potential benefits of laparoscopic surgery include less postoperative pain, decreased hospitalization, and earlier return to normal activities. The use of laparoscopic gastrectomy is limited, however. Only patients with early stage gastric cancers or those whose surgery is only intended for palliation—pain and symptomatic relief rather than cure—should be considered for this minimally invasive technique. It can only be performed by surgeons experienced in this type of surgery.
Caroline A. Helwick, The Gale Group Inc., Gale, Detroit,