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  • Q&A with Australian Health Practitioners

    Surgery for gastric cancer - what is the success rate and what should a patient expect following the procedure?

    Related Topics
    Cancer Gastric Cancer
    • 2 answers
    • Dr Salena Ward
    • Mr Dean Spilias
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    Dr Salena Ward

    Bariatric (Obesity) Surgeon, General Surgeon, Upper GI Surgeon (Abdominal)

    I am a specialist Upper Gastrointestinal (gut) Surgeon, who performs surgery for weight loss, tumours of stomach and oesophagus, reflux, hiatus hernia and gallstones. I … View Profile

    Regarding success rate (of cure) of surgery for gastric cancer, it is difficult to answer this question as it depends on several features of the cancer, such as type of cancer, type/extent of surgery performed, how ‘large/extensive’ the cancer is (eg how far has the cancer grown through the stomach wall, has it spread to any lymph nodes?), whether cancer spread has been looked for preoperatively, etc.

    To give you a vague idea of the range of success of cure, if the cancer is very small and only on the inner-most lining of the stomach, the long term cure rate could be as high as >90%. However if the cancer is growing through the wall of the stomach and/or into lymph nodes, long-term cure may only be achieved in one third of patients.  I would recommend if you have had gastric cancer surgery and want to know the answer to this in your circumstance you should have a frank discussion with your surgeon and other oncological (cancer) team about this.

    Regarding the question about what to expect following a surgical procedure for gastric cancer, again this is difficult to answer simply as it depends on a few factors, such as how long after the surgery you are asking about, where the cancer was and hence what type and extent of surgery was performed, etc.

    Just after the operation you will have at least several days recovery in hospital, and slowly get back onto diet and activity as instructed by your surgeon. This surgery can have several different complications which may require treatment, further procedures and/or longer hospital stay.

    Once home, weeks to months, you will be slowly increasing your activity and also adjusting to a different diet depending on the new anatomy of your upper gut, you may have lost weight and are now trying to regain some weight and strength.  Your stools are likely to be a bit erratic and you may have loose stools (diarrhoea) or constipation (which may be due to pain medications).

    Later on, months to years, you may be feeling better but you may still be adjusting your diet and your bowel function may still be trying to get back to some sort of regularity and normality.  Sometimes you need extra advice regarding your digestion capacity, diet and bowel function. Also over this period you will be having reviews by your surgeon or other specialists to look for any symptoms of recurrence of the cancer, and if any symptoms or signs present you may need further tests.

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    Mr Dean Spilias

    Upper GI Surgeon (Abdominal)

    Dean graduated from the University of Melbourne in 1997 and went on to surgical training at the Royal Melbourne Hospital. During his residency he had … View Profile

    The cure rate of gastric cancer depends on the tissue type of the cancer, the stage of the cancer, and the fitness and symptoms of the person affected by the cancer. 

    The common tissue type of gastric cancer is called an adenocarcinoma. This is a cancer that arises from the glands in the lining of the stomach. 

    The stage of the cancer depends on 3 main factors;

    1. The depth of invasion of the cancer into (or through) the somach, called the T-stage (T for tumour); 
    2. Whether the cancer has spread to the lymph nodes around the stomach, the N stage; 
    3. Whether the cancer has metastasised (spread) to other parts of the body, such as the other organs in the abdominal (belly) cavity, or the liver or lungs. This is the M stage. 

    The T, N and M scores are combined to give an overall stage, which goes from 1 to 4. Here's a link that describes these in more detail: http://www.cancer.gov/cancertopics/pdq/treatment/gastric/Patient/page2

    Unfortunately it isn't possible to give a single cure rate for gastric cancer, but your surgeon or oncologist should be able to tell you where you stand based on the above factors. 

    Treatment for gastric cancer usually involves a combination of chemotherapy and surgery, and also radiotherapy in some cases. Often the process will involve chemotherapy, surgery, then further chemotherapy and possibly radiotherapy. Early stomach cancers can sometimes be treated with surgery alone.

    Treatment should be discussed by a multidisciplinary team of surgeons, oncologists, radiation oncologists and other specialists to ensure that all options are considered, and that any  relevant clinical trials are considered. Clinical trials compare different treatment options in the hope of improving treatments in the future; a list of currently open trials can be found here: http://agitg.org.au/clinical-trials/trials-open-to-recruitment/

    Surgery can be laparoscopic (keyhole) or open (large incision). Not all surgeons perform laparoscopic stomach surgery. 

    The hospital stay following surgery can be from 5 days to two weeks, depending on the operation and how well recovery proceeds. 

    It is normal to lose weight following surgery - 10% of body weight is common - and to need to snack or graze on small, high-protein meals after surgery. Large meals are usually not tolerated, due to the smaller size of the stomach. Meals high in sugar should be avoided, they can cause headaches, dizzyness and diarrhoea after stomach surgery. 

    Most people will need vitamin B12 injections every 3 months, lifelong, following surgery for stomach cancer. 

    Modern methods of reconstruction (joining everything up again) after surgery, such as Roux-en-Y reconstruction, decrease symptoms such as reflux which can occur after stomach surgery. 

    Follow up after treatment is usually with CT scanning (CAT scan) and gastroscopy. This should continue for at least five years after treatment is completed. 

    Other places to ask for support include:

    The Australian Cancer Council http://www.cancer.org.au/ has resources and links to support groups in each state, they also have a Helpline, Tel. 13 11 20 which is open during business hours.
     
    The Victorian Better Health Channel, http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Stomach_cancer

    Hope this helps!

    Dean Spilias
    http://www.uppergi.net

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