Total Gastrectomy for Stomach (Gastric) Cancer

Stomach cancer occurs when abnormal cells develop in the stomach lining. It’s a stealthy condition. Early signs are rare, but later symptoms include chronic indigestion, weight loss, and abdominal pain. Once confirmed through biopsies, surgery is usually the frontline defence. If the tumour is too large for partial removal, a Total Gastrectomy is the standard protocol. This involves the complete removal of the stomach and nearby lymph nodes.

To maintain digestive function, surgeons reconstruct the tract, joining the oesophagus to the small bowel. While a major operation, it is handled by senior gastrointestinal specialists. The primary goal remains the eradication of malignancy and the surgical reconstruction of the digestive route.

Total gastrectomy involves the surgical removal of the entire stomach, usually to treat gastric cancer. The operation includes the excision of the stomach and adjacent lymph nodes to prevent further spread. Post-excision, the digestive tract is reconstructed by joining the oesophagus directly to the jejunum, allowing food passage to continue.

The surgical approach, whether open, laparoscopic, or robotic, is determined by the patient’s specific needs and the surgeon’s clinical judgment. Given its complexity, this is a major procedure performed by senior gastrointestinal or oncologic surgeons. It is a definitive treatment path aimed at eliminating malignancy while maintaining a functional, albeit modified, digestive system.

Total gastrectomy is the recommended course when stomach cancer is extensive or situated in areas unsuitable for partial removal. CT scans and biopsies provide the necessary data to map the tumour’s location and size before the surgical team proceeds.

Total gastrectomy is generally used for:

• Tumours located in the upper or middle parts of the stomach
• Cancers involving more than one region of the organ
• Diffuse-type gastric cancer that moves through the lining
• Situations where total removal is the only way to ensure clear margins
• Cases where cancer has reached the lymph nodes and requires excision
• Hereditary conditions that significantly increase stomach cancer risks

It is worth noting that a total gastrectomy is only one of several options for stomach cancer. We only recommend it after looking at how far the cancer has spread and checking that you are feeling well enough for surgery.

This procedure might be right for:

• Patients whose cancer covers a lot of the stomach area
• Cases where a partial gastrectomy wouldn't be safe or effective
• People with lymph node spread that can still be cleared by a surgeon
• Individuals who are physically fit for a major abdominal procedure
• Patients who will benefit from surgery alongside other treatments

We approach total gastrectomy as a selective surgical tool for gastric cancer. Before recommending surgery, we thoroughly review your fitness and the cancer’s stage. Unfortunately, this surgery is not suitable for everyone, particularly those with distant metastases, high-risk co-morbidities, or poor physiological reserve. We also avoid this major surgery for patients with severe heart or respiratory limitations, or when the cancer’s profile indicates that systemic chemotherapy would be a much safer, more effective approach.

The operation takes place in an operating theatre while you are under general anaesthesia, so you will be in a deep sleep the whole time. Your surgeon will sit down with you beforehand to explain exactly what will happen and talk through any worries you might have.

To prepare, the medical team will thoroughly review your history and test results. You will usually be asked to:

• Avoid any food or drink for several hours before your surgery
• Let your doctor know about every medication you are taking
• Stop taking blood-thinning pills if your team advises it
• Follow all the guidance given in your pre-op information pack

When you’re ready for your total gastrectomy, you’ll be gently put to sleep with a general anaesthetic. Your surgeon then begins, either through one larger opening or several tiny keyhole spots if using a camera. The main goal is to remove the stomach and nearby lymph nodes to clear away any cancer and prevent it from returning. To ensure you can still eat, the surgeon efficiently reconnects your food pipe (the oesophagus) directly to your small bowel. This path is checked thoroughly for leaks before the incisions are closed. It’s a long operation, but we’ll look after you throughout.

After surgery, patients go to a recovery room to wake up from the anaesthetic. A hospital stay of several days is usually necessary so the team can watch your progress and check for any problems.

In the early days after surgery:

• You will likely receive your nourishment through a drip at first
• We will slowly introduce sips of water and soft foods as you feel ready
• We will provide plenty of pain relief to keep you feeling settled
• Our nurses will help you take gentle steps to get you moving again

Since your stomach has been removed, you will find that eating feels a bit different. We usually suggest eating smaller meals more often. The tissue and lymph nodes we removed are sent to the lab for a check-up. These results help your doctors understand the stage of the cancer and plan any extra care you might need.

Total gastrectomy is a major surgical procedure, and like all surgeries, it carries certain risks. Patients are monitored carefully during and after the operation to detect any concerns early.

Possible complications may include:

• Some bleeding during or after the surgery
• An infection where the operation took place
• A small leak where the oesophagus is joined to the bowel
• Blood clots forming in the legs or the lungs
• Reduced nutrient absorption may occur

In the long run, you might notice changes in your digestion or some weight loss. You may need vitamin boosts, like B12, since your stomach used to help with this. Your doctors will guide you through your new diet and follow-up care.

For total gastrectomy patients, we offer a structured, multi-phase care programme. Our specialists in gastrointestinal and cancer surgery utilise advanced operating theatres, supported by a multidisciplinary team. We provide:

• Advanced diagnostic and imaging services
• Dedicated critical care and monitoring
• Full peri-operative guidance

We ensure rigorous clinical evaluation and a tailored treatment plan for every patient. Your health is our priority.

A total gastrectomy removes the entire stomach and nearby lymph nodes to treat cancer. Surgeons then reconstruct the digestive tract, linking the oesophagus directly to the small intestine. Doctors advise this if the cancer affects much of the stomach. Thankfully, modern surgical advances and better aftercare have led to much better outcomes for many people.