Stomach Cancer Treatment: Partial vs. Total Gastrectomy
Introduction
Deciding between a partial or total gastrectomy can mean the difference between preserving gastric function and preventing stomach cancer recurrence.
“The main factors that go into deciding the type of surgery to perform are the location and size of the cancer,” said Dr. Aslam Ejaz, Chief Surgical Oncologist at the University of Illinois Chicago (UIC), part of UI Health. “Depending on where the cancer is determines whether we are able to save some or any of the stomach.”
Through minimally invasive robotic approaches, the oncology team at UIC can perform highly precise gastric surgeries with smaller incisions, less pain, and faster recovery times—delivering the most advanced, patient-centered cancer care available.
“With our technique and experience here, we are able to offer the majority of our patients a minimally invasive gastric resection,” said Dr. Ejaz. “This instills confidence in patients who may be able to return to normalcy following their cancer removal.”
Causes & Stats
Though family history and genetic conditions are factors, the two most common causes leading to stomach cancer in the US are smoking and alcohol.
According to the American Cancer Society, stomach cancer accounts for roughly 1.5% of all new cancer diagnoses in the U.S. each year, with over 30,000 new cases of stomach cancer annually (17,720 occurring in men and 12,580 in women) in the United States. These numbers highlight the importance of awareness, early detection, and access to expert surgical care.
Partial vs. Total Gastrectomy
A partial gastrectomy is a surgical procedure in which a portion of the stomach containing the tumor is removed, along with nearby lymph nodes.
A total gastrectomy is when the entire stomach is removed. After removal, the esophagus is directly connected to the small intestine, allowing food to continue through the digestive system.
The decision between the two procedures is dependent on the location and growth of the cancer. “If the cancer is located in the distal portion (lower section of the stomach), away from the esophagus, we would likely be able to save a decent amount of the stomach, and the patient would be eligible for a partial gastrectomy,” stated Dr. Ejaz. “However, if it is in the proximal portion (upper portion), closer to the esophagus, it is usually unlikely that we would be able to save any of the stomach.
“Our goal is always to preserve as much stomach as possible when removing the tumor while keeping in mind that patients must return to normal life in terms of eating,” Dr. Ejaz said.
Risk Factors
A common post-surgery effect, particularly after a total gastrectomy, is dumping syndrome. This occurs when food moves too quickly from the stomach into the small intestine, leading to symptoms such as diarrhea, nausea, stomach cramps, and vomiting. The condition occurs when food and gastric juices enter the small intestine suddenly due to the removal of the stomach.
The team at UIC prepare patients for the potential risk by working with their team of oncologists and dieticians to propose eating smaller meals throughout the day, especially foods that are high in sugar.
Delayed gastric emptying (DGE) is a more common occurrence in patients who have undergone a partial gastrectomy, in which the stomach may take longer to empty food into the small intestine. This delay is often related to surgical disruption of the stomach’s nerves.
Dr. Ejaz on UIC's Multidisciplinary approach
We work closely with a team, including oncologists, radiologists, nutritionists, and gastroenterologists, to assess every patient to along their cancer journey to carefully create individualized plans.
Minimally Invasive & Multidisciplinary
“The biggest advancements have been in the minimally invasive approach to treating gastric cancer—whether partial or total,” said Dr. Ejaz.
Both partial and total gastrectomies can be performed using minimally invasive techniques. Through minor incisions—less than an inch—in the abdomen, the oncology team is able to perform the precise resection of tumors or any part of the organ with the same quality of efficiency and safety as an open surgery. The benefits of the minimally invasive approach come in the form of quicker recovery times for patients due to the minor incisions required.
Even beyond the removal of cancerous tumors, this approach lends itself to further post-surgery treatments. In treating DGE, surgeons can perform a minimally invasive anastomosis, connecting the remaining portion of the stomach directly to the small intestine to create a new digestive outflow.
“Another major advancement is how we treat patients before and after surgery,” Dr. Ejaz said of the multidisciplinary team of oncologists, radiologists, and gastroenterologists. “We try to optimize them before surgery to make sure their protein levels are adequate, so they can heal appropriately after the procedure.”
UIC offers each patient an individualized treatment plan created by a team of specialists, no matter where they are on their cancer journey. “After the surgery, we have enhanced recovery protocols to get patients moving around and eating normally faster,” he continued.
The Results Are In
As a high-volume center, UIC follows these established protocols to optimize patients’ care throughout their treatment by educating them on their condition, preparing them for surgical intervention, and promoting faster recovery times. In addition to surgical innovation, UIC has access to new clinical trials for emerging therapies and treatments, staying at the forefront of advanced cancer care and patient recovery.