Removal of all (total) or part (subtotal) of the stomach with D2 lymph node dissection in gastric cancer and complex stomach diseases.
Indication
- Surgical treatment of gastric cancer (gastric adenocarcinoma)
- Lymphoma in the stomach region and gastrointestinal stromal tumor (GIST)
- Advanced complications of peptic ulcer disease unresponsive to medical therapy (perforation, bleeding, stricture)
- Recurrent complications related to prior gastric surgery
- Severe and irreversible gastric outlet obstruction
- Prophylactic gastrectomy in certain hereditary syndromes (specialized indication)
Preparation
- Diagnosis confirmed by upper gastrointestinal endoscopy and biopsy
- Staging with CT, and endoscopic ultrasound (EUS) and PET-CT when needed
- Complete blood count, biochemistry, coagulation studies, and nutritional status (albumin) assessment
- Smoking cessation, nutritional support, and adjustment of blood thinners
- At least 8 hours of fasting and skin preparation before the operation
How it's performed
- The abdomen is opened by an open or laparoscopic approach under general anesthesia
- The stomach is removed totally (total gastrectomy) or partially (subtotal/distal gastrectomy) according to tumor location
- Surrounding tissues and a D2 lymph node dissection are performed; appropriate surgical margins are achieved
- A new connection between the esophagus and small intestine is created with an appropriate technique (Roux-en-Y)
- The abdomen is irrigated, bleeding is controlled, and a drain is placed
- Removed tissue and lymph nodes are sent for pathology
Post-procedure
- After intensive care follow-up, transfer to the ward; total hospital stay is typically 7-14 days
- Liquid diet in the first days, followed by gradual transition to soft and solid foods
- Frequent small meals (especially after total gastrectomy to reduce dumping)
- Vitamin B12, iron, calcium, and overall nutritional follow-up (long-term supplementation if needed)
- Adjuvant chemotherapy/radiotherapy planning together with oncology based on pathological stage
Risks
- Anastomotic leak or stricture
- Bleeding, infection, and intra-abdominal abscess
- Nutritional deficiencies (weight loss, B12 and iron deficiency)
- Dumping syndrome (palpitations, sweating, diarrhea after eating)
- Thromboembolic and respiratory complications
FAQ
After my entire stomach is removed, can I eat normally?
Yes, but in frequent small meals. With dietitian support, a gradual transition to different foods is achieved.
Are vitamin supplements needed after total gastrectomy?
Yes. Vitamin B12 in particular is given lifelong as injections or as high-dose oral supplementation; iron and calcium deficiencies are also monitored.
Will chemotherapy definitely be needed?
The need is determined by pathological stage, lymph node involvement, and molecular features; it is planned at a multidisciplinary tumor board.
Is laparoscopic surgery possible?
Depending on tumor location, stage, and patient condition, laparoscopic gastrectomy may be preferred in suitable cases.
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