Surgery to remove cancer from the stomach or the esophagus depends on the size and location of the tumor.
Gastrectomy is an operation to take out some or all of the stomach.
A partial gastrectomy removes the upper part of the stomach and connects the remaining stomach with the esophagus.
A total gastrectomy removes all of the stomach. The esophagus is then connected to the small intestine.
Esophagectomy provides the best chance for survival for patients whose cancer is just in the esophagus. Most of the esophagus and nearby lymph nodes are removed. The stomach is brought up and attached to the remaining esophagus.
Esophagogastrectomy removes most of the esophagus, nearby lymph nodes and the upper part of the stomach. The remaining stomach is brought up and connected to the remaining esophagus.
During the surgery, the surgeon will insert the medical instruments and camera through incision sites (known as ports). The number and sizes of incisions you will have depends on the type of surgery.
Robotic-assisted surgery: you will have several small incisions in your abdomen and a slightly longer one in your neck.
Thorocoscopic-laproscopic surgery: you will have small incisions in your abdomen, the right side of your chest, and a slightly longer one in your neck.
Found too late, esophageal cancer is often deadly. Found early enough, it can be treated with surgery. Abbott Northwestern Hospital is one of the few places in the United States where a surgical robot is being used to remove cancer from the esophagus.
Source:Virginia Piper Cancer Institute Reviewed by: Daniel Dunn, MD, medical director, Virginia Piper Cancer Institute Esophageal and Gastric Cancer Program First Published: 10/29/2009 Last Reviewed: 10/29/2009
Whether you are an esophageal or stomach cancer survivor or are undergoing cancer treatment, you may face symptoms that interfere with daily life. Our cancer rehabilitation team can help. Call 612-863-8947.
Participating in a clinical trial may help you take a more active role in your health care. You may also gain access to new drugs, treatments and disease management practices.
Stages of stomach and esophageal cancer
When diagnosed with stomach cancer or esophageal cancer, you will learn what stage the cancer is at. This can help you and your care team determine your goals, treatment options and outlook.
Our doctors use the TNM staging system to define the stages of stomach and esophageal cancer. In general, early stage cancers have a better prognosis than late stage cancers.
Classification
Stomach cancer stages
Esophageal cancer stages
T is for 'tumor'
T1 tumors start in the lining of the stomach.
T2 tumors have gone through the muscle but not outside th wall of the stomach.
T3 tumors are in the outside lining of the stomach wall (serosa).
T4 tumors have gone outside the stomach wall and into nearby organs or tissue.
T1 tumors are below the lining ofthe esophagus.
T2 tumors are in the muscular wall of the esophagus
T3 tumors are in the outer extent of the esophagus.
T4 tumors have gone through the wall of the esophagus into nearby areas such as the trachea (breathing tube).
N is for 'lymph' nodes.
N1 means cancer is in 1 to 6 lymph nodes near the stomach.
N2 means cancer is in 7 to 15 lymph nodes in the stomach region.
N3 means cancer is in more than 15 lymph nodes.
N0 means no lymph nodes have cancer.
N1 means there are lymph nodes with cancer cells
M is for 'metastatic' spread.
M0 means the cancer is only in the stomach.
M1 means the cancer has spread to the liver or other organs
M0 means the cancer is only in the esophagus.
M1 means the cancer has spread to other organs.
Tumors reach different layers of the stomach
The stomach has five layers:
The mucosa is the inner layer or lining. It is made up of glands that secrete the juices that help digest food.
The submucosa supports the inner layer.
The muscle layer contracts and creates a rippling motion that mixes and mashes the food.
The subserosa covers and supports the muscle layer.
The serosa covers and holds the stomach in place.
Source:Virginia Piper Cancer Institute Reviewed by: Daniel Dunn, MD, medical director, Virginia Piper Cancer Institute Esophageal and Gastric Cancer Program First Published: 10/29/2009 Last Reviewed: 10/29/2009
Robotic-assisted surgery
Robotic-assisted surgery photo tour
The photo tour below will explain and illustrate what will happen during your surgery.
To begin, click on the first image below.
Select the "Next" button in the top right of the image to advance to the next image.
Medical robot treats esophageal cancer
Found too late, esophageal cancer is often deadly. Found early enough, it can be treated with surgery. Abbott Northwestern Hospital is one of the few places in the United States where a surgical robot is being used to remove cancer from the esophagus.
Source: Allina Patient Education, Your Esophageal Cancer Surgery, surg-ahc-93825 Reviewed by: Allina Patient Education experts First Published: 05/15/2009 Last Reviewed: 05/15/2009
Risks/complications of surgery
As with any surgery, there are possible risks and/or complications involved. These can include the following:
general anesthesia risks
bleeding that requires a blood transfusion or another surgery
leak from anastamosis (surgical connection)
vocal cord injury causing voice changes or problems with swallowing (This is usually temporary.)
infection at an incision site
pneumonia
other respiratory problems that require breathing support
heart attack, stroke or blood clots
weakness, loss of muscle strength that requires rehabilitation
scarring or tightening of the new connection between the stomach and esophagus, known as stricture (Many patients need at least one — possibly several — stretching procedures to keep the connection open.)
the possibility that the cancer can’t be removed
other.
You may have others that are not on this list. Please talk with your surgeon about any concerns or questions you have.
Thorocoscopic-laproscopic surgery
Sometimes it is necessary for the surgeon to go through the chest to free up the esophagus. You may need this type of surgery if:
the location of your tumor is higher up in the esophagus
you have certain medical conditions that would make this type of surgery better for you
you have already had surgery in the chest or abdomen area.
Your surgeon will explain the reasons why this surgery is better for you.
Thoracoscopic incision sites
Before surgery, you will receive medicine (anesthesia) to make you fall asleep. You will be placed on your left side.
The thoracic (chest) surgeon will lead this portion of surgery. Your right lung will be deflated for a short time so the surgeon can have better access to your esophagus.
The surgeon will make four incisions, each about one-half inch, on the right side of your chest. These incisions, or ports, are used for the video camera and instruments used during your surgery.
Moving the esophagus
The surgeon will loosen (or free-up) the esophagus. When this part of the surgery is completed, a chest tube will be inserted to re-inflate your right lung.
The chest tube will remain in place for several days after surgery to make sure your lung remains inflated and to drain any fluid that might collect.
Surgery
