Each year, about 22,000 Americans will be diagnosed with cancer of the stomach, also known as gastric cancer. In the standard "open" surgical approach to treating stomach cancer, surgeons make an incision through the abdominal muscles to remove either all or parts of the stomach, nearby lymph nodes, and in some cases, other affected organs. For selected patients, Memorial Sloan-Kettering Cancer Center offers a minimally invasive laparoscopic surgical approach, which produces comparable success rates to the open procedure, with fewer complications, less blood loss and postoperative pain, and a shorter hospital stay.
Stomach Cancer and Its Treatment
The choice of treatment for stomach cancer largely depends on how much the tumor has grown, how deeply it has invaded the layers of the stomach, and whether it has spread to nearby organs, lymph nodes, or other parts of the body. Based on these factors, a patient's treatment plan may include surgery, chemotherapy, radiation therapy, or a combination of these therapies.
If surgery is the best treatment option, the doctor may perform one of two surgical procedures, depending on the location of the tumor. In the first, known as a partial, or subtotal, gastrectomy, the surgeon removes part of the stomach with surrounding lymph nodes, as well as parts of other tissues or organs near the tumor. In the second procedure, known as total gastrectomy, the surgeon removes the entire stomach with surrounding lymph nodes and parts of the esophagus, small intestine, and other tissue near the tumor. The complete removal of nearby lymph nodes, which are then carefully examined for cancer cells to determine whether the cancer has spread, is an important part of a complete cancer surgery. Following total gastrectomy, the esophagus is directly connected to the small intestine, allowing the patient to continue to eat and swallow normally, although with smaller portions of food.
Minimally Invasive Stomach Surgery -- Laparoscopic Gastrectomy
Laparoscopic gastrectomy allows removal of the same structures, including complete lymph node retrieval, as open surgery. In the procedure, the surgeon works through five small incisions in the abdominal wall -- four that are 5 millimeters in length and one that is 12 millimeters. A thin, lighted tube with a video camera at its tip, called a laparoscope, is inserted through one of the incisions, and the image is projected onto a large viewing screen. Guided by this highly magnified image, the surgeon can operate through the other surgical "ports" using specially designed surgical instruments. All structures and tissues that are surgically removed are placed in a special bag to avoid leaving tumor cells behind. The bag is then removed through the largest incision.
Laparoscopic gastrectomy is a complex surgical procedure. Consequently, the experience of the surgeon performing the procedure is an important factor in terms of tumor control and post-surgical complications. About 100 to 120 gastrectomies, both open and laparoscopic, are performed each year at Memorial Sloan-Kettering -- which is one of the highest volumes of surgery for this relatively rare cancer of any center in the country. The first laparoscopic gastrectomy performed at Memorial Sloan-Kettering was done in 2001. Since 2005, approximately 75 patients have had their stomach cancers treated laparoscopically.
