Gastrectomy

About Gastrectomy

Gastrectomy is the surgical removal of all or part of the stomach. Its main indication is gastric cancer, which is among the most common cancers worldwide and is especially frequent in East Asia; other indications include some gastrointestinal stromal tumors, complicated peptic ulcer disease and, in the form of sleeve gastrectomy, severe obesity. Types include total gastrectomy, distal or subtotal gastrectomy, which removes the lower part of the stomach, and proximal gastrectomy. The first successful gastrectomy for cancer was performed by the Austrian surgeon Theodor Billroth in 1881, and the Billroth I and Billroth II reconstructions still bear his name. For cancer, removal of the surrounding lymph nodes is an important part of the operation, and D2 lymphadenectomy along the named arteries is regarded as the standard in many countries. After total gastrectomy, continuity is usually restored with a Roux en Y esophagojejunostomy. Losing the stomach reservoir changes digestion: dumping syndrome can cause symptoms soon after eating from rapid emptying of food into the small intestine, or later from low blood sugar. Absorption of vitamin B12, iron, calcium and other nutrients is affected, so long term nutritional monitoring and replacement are part of follow up care, and weight loss is common. Complications of the operation include anastomotic leak, bleeding, infection and bile reflux. Laparoscopic and robotic gastrectomy are widely performed, particularly in Japan and Korea. For locally advanced cancer, chemotherapy given before and after surgery has been shown to improve survival.