Gastric Cancer Surgery

Introduction

Gastric cancer, or stomach cancer, is a major worldwide health problem, especially in East Asia. Though chemotherapy and radiotherapy are important components of treatment, gastric cancer surgery is frequently the mainstay of curative treatment, particularly in the case of early to locally advanced gastric cancer. This article addresses all that you want to know about gastric cancer surgery—ranging from types of surgery, treatment processes, risks, patient feedback, costs in major nations, and current clinical trials in China.

About the Disease

Gastric cancer typically starts in the stomach lining and is most often an adenocarcinoma. The disease can progress silently and is usually detected at an advanced stage. Key risk factors include:

• Helicobacter pylori infection

• Smoking and alcohol use

• Diets high in salt, smoked, or pickled foods

• Chronic gastritis or gastric ulcers

• Genetic mutations (e.g., CDH1 gene)

Stomach cancer staging is crucial and determines whether surgery is feasible. It is classified as:

• Early-stage: Cancer limited to the inner lining

• Locally advanced: Involves deeper layers or nearby lymph nodes

• Metastatic: Spread to distant organs like the liver or peritoneum

Indications for Surgery

Surgical removal of the tumor is considered the most effective curative option for gastric cancer in the following cases:

• Resectable early-stage cancer

• Locally advanced cancer without distant metastasis

• Bleeding or obstructing tumors causing severe symptoms

• In some cases of recurrence, where the tumor remains localized

Surgery may also be considered for palliative purposes in metastatic disease—such as relieving obstruction or bleeding.

Treatment Details

Surgical techniques vary based on the tumor location, size, stage, and patient condition. Types of gastric cancer surgeries include:

1. Subtotal (Partial) Gastrectomy

• Removes part of the stomach (usually lower two-thirds).

• Used for tumors located in the lower part of the stomach.

• May be open, laparoscopic, or robotic.

2. Total Gastrectomy

• Removes the entire stomach.

• Required for tumors involving the upper stomach or spread throughout the stomach.

• A new connection (esophagojejunostomy) is created between the esophagus and small intestine.

3. Proximal Gastrectomy

• Used for tumors in the upper third of the stomach.

• Less common due to higher risk of reflux complications.

4. Palliative Surgery

• Bypass or partial resection to relieve symptoms like obstruction or bleeding.

Lymphadenectomy

• Removal of surrounding lymph nodes (D1 or D2 dissection) is crucial to reduce recurrence.

Minimally Invasive Techniques:

• Laparoscopic gastrectomy: Smaller incisions, quicker recovery

• Robotic gastrectomy: Enhanced precision with lower complication rates

Surgery is often combined with neoadjuvant chemotherapy (before surgery) or adjuvant chemotherapy (after surgery) to improve survival.

Medicines Used

Surgery doesn’t typically involve long-term medication unless combined with chemo or used for supportive care.

Common drugs include:

• Antibiotics: To prevent postoperative infections

• Painkillers: Such as opioids or NSAIDs

• Proton pump inhibitors (PPIs): To reduce gastric acidity

• Antiemetics: To manage nausea

• Anticoagulants: For deep vein thrombosis (DVT) prevention

Postoperative chemotherapy may include 5-FU, capecitabine, oxaliplatin, or FLOT regimen drugs.

Effectiveness

Gastric cancer surgery offers the best chance of cure in early and selected locally advanced cases:

• 5-year survival rate for early-stage surgically treated patients: Over 90%

• Stage II–III with surgery + chemo: 35%–60% survival

• Total vs subtotal gastrectomy: Comparable survival, decision based on location and size

• D2 lymph node dissection: Associated with lower recurrence

When performed by experienced surgeons in high-volume centers, surgery can significantly reduce mortality and improve quality of life.

Risks and Side Effects

Surgery for gastric cancer is a major procedure and carries potential risks.

Short-Term Complications:

• Bleeding

• Infection

• Anastomotic leak (leakage from the surgical connection)

• Lung or heart complications

• Delayed gastric emptying

Long-Term Effects:

• Dumping syndrome (rapid gastric emptying)

• Nutritional deficiencies (vitamin B12, iron, calcium)

• Weight loss and poor appetite

• Reflux and diarrhea

• Changes in digestion

With proper nutritional support and follow-up care, most of these issues can be effectively managed.

Recovery and Aftercare

Postoperative recovery depends on the extent of surgery and the patient’s condition.

Hospital Stay:

• 7–10 days after open surgery

• 5–7 days after laparoscopic or robotic surgery

Initial Care:

• IV fluids and pain management

• Gradual progression from liquids to solids

• Drain and catheter removal within a few days

• Respiratory exercises to prevent pneumonia

Long-Term Follow-Up:

• Small, frequent meals

• Vitamin B12 injections (especially after total gastrectomy)

• Calcium and iron supplementation

• Regular oncologist follow-ups (PSA, scans)

• Psychological counseling and support groups

Cost and Availability

Surgery for gastric cancer is widely available across Asia, Europe, and North America. Costs vary significantly depending on hospital type, location, surgeon expertise, and additional therapies.

In India:

• Open gastrectomy: ₹1.5 – ₹2.5 lakhs ($1,800 – $3,000)

• Laparoscopic/robotic: ₹2.5 – ₹5 lakhs ($3,000 – $6,000)

• Additional chemotherapy can increase the total cost

In China:

• Open gastrectomy: ¥40,000 – ¥70,000 ($5,600 – $9,800)

• Robotic/laparoscopic: ¥80,000 – ¥120,000 ($11,000 – $17,000)

• Coverage often available via national health insurance

Patient Experiences

Many patients who undergo gastric cancer surgery report positive outcomes, particularly when diagnosed early and supported with proper rehabilitation.

Real quotes:

• “My surgery went well, and I’m eating normally in small portions.”

• “I lost weight at first, but with nutrition counseling, I feel strong again.”

• “Robot-assisted surgery helped me recover fast and avoid major scars.”

Emotional resilience, diet support, and regular follow-ups play a vital role in post-surgical recovery.

Cost in Countries Like China, India, Israel, Malaysia, Korea, Thailand, Turkey, and USA

Includes surgery, anesthesia, hospital stay, and basic aftercare.

List of Ongoing Clinical Trials in China

China is conducting extensive research in gastric cancer surgery, often integrating robotics, AI, and perioperative care. Notable ongoing clinical trials include:

1. Robotic vs Laparoscopic Gastrectomy

   • Comparing safety and outcomes

   • Status: Phase III

2. Enhanced Recovery After Surgery (ERAS) Protocols

   • Reducing complications and hospital stay

   • Status: Phase III

3. Immunonutrition Before Surgery

   • Prehabilitation to improve surgical outcomes

   • Status: Phase II

4. Sentinel Lymph Node Mapping in Gastric Cancer

   • Minimizing unnecessary lymph node dissection

   • Status: Phase II

5. AI-Powered Surgical Planning Tools

   • Improving precision and minimizing complications

   • Status: Pilot studies

Leading research centers include Fudan University Shanghai Cancer Center, Beijing Cancer Hospital, and Sun Yat-sen University Cancer Center.

FAQ

Is surgery the best treatment for gastric cancer?

Yes, for early and localized stages, surgery offers the best chance for cure. Advanced cases often need chemo-radiotherapy.

What type of surgery is best?

Subtotal gastrectomy for distal tumors and total gastrectomy for diffuse or proximal cancers. Choice depends on tumor location and spread.

Can I live a normal life without a stomach?

Yes. With dietary adjustments and vitamin supplementation, patients can lead full lives.

How soon can I eat after surgery?

Usually after 3–5 days, starting with liquids and slowly progressing to solids.

What is the recovery time?

Full recovery takes 4–6 weeks for laparoscopic and 6–8 weeks for open surgery.

Is gastric cancer surgery available in India and China?

Yes. Top-tier cancer hospitals in both countries offer advanced gastric cancer surgery with affordable options and skilled specialists.