The decision about whether to remove the stomach depends on whether the tumor has invaded the adjacent bowel above and below the stomach, the lower part of the stomach near the duodenum or the junction of the esophagus and the upper part of the stomach. If it hasn't, up to 85 percent of the stomach is removed, along with the first portion of the small bowel (duodenum), nearby lymph nodes and the pad of fat (omentum) between the bowel and the lining of the abdominal cavity.
A CT scan may be helpful in detecting the margins of the cancer and lymph node involvement. Since it may seem to indicate more extensive disease than is really present, the CT result alone should not be a reason to avoid surgery.
This is major surgery. The incision may run from the chest down to the navel. All of the stomach must be removed if there is extensive stomach involvement. The esophagus may have to be connected to the mid-small bowel (esophagojejunostomy) and a gastric pouch constructed.With a total gastrectomy, 5 percent of patients may not survive the operation and there may be significant complications.
