Surgeons are returning to abandoned techniques and adopting colorectal methods to improve quality of life for stomach cancer patients, according to Travis Grotz, M.D., a Mayo Clinic surgical oncologist.
While traditional operations often removed the entire stomach, current innovations focus on preserving organ function and reducing post-surgical complications.
“The patients’ quality of life was negatively impacted,” said Dr. Grotz regarding the historic challenges of proximal gastrectomy. This procedure, which removes the upper portion of the stomach, was once largely abandoned in the U.S. because it frequently caused severe bile reflux.
Surgeons are now revisiting the operation using double-tract reconstruction, a technique that alters how the remaining stomach, esophagus, and intestine connect. By modifying these pathways, surgeons can remove cancerous tissue while preserving part of the stomach. Dr. Grotz notes that this refined approach reduces the incidence of reflux to approximately 5%.
Adapting Colorectal Reservoirs to Restore Digestion
Total gastrectomy, or the complete removal of the stomach, eliminates the body’s natural food reservoir, often leading to “dumping syndrome” where food enters the small intestine too rapidly. To combat this, surgeons are applying a concept from colorectal surgery: the creation of a J-pouch.
“The pouch holds on to the food for about 90 minutes, and then it slowly releases it,” said Dr. Grotz. By using a segment of the small intestine to create this reservoir, patients can often return to eating three normal-sized meals a day. Dr. Grotz estimates that more than 80% of patients who receive a pouch experience this improvement in daily living.
Endoscopic Treatment for Early-Stage Diagnosis
Not all stomach cancers require conventional surgery. For patients diagnosed early, physicians may utilize an endoscope to remove the tumor without performing a traditional incision. This minimally invasive option depends on specialized expertise, and Dr. Grotz suggests that patients should prioritize centers with the necessary experience to evaluate whether they are candidates for endoscopic removal rather than larger operations.
For locally advanced cases, treatment plans are increasingly individualized. Surgeons now coordinate surgery with immunotherapy and chemotherapy. “Surgery is a great consolidative therapy,” said Dr. Grotz. “If you’ve had a great induction response to therapy, then it’s very effective to consolidate with surgery and get rid of the rest of the cancer.”
Rising Incidence in Younger Populations
The clinical profile of stomach cancer in the U.S. is shifting, with more diagnoses appearing in younger adults and in different regions of the stomach than in previous decades. Researchers are currently investigating the potential role of ultraprocessed foods in this trend.
While current evidence shows an association rather than direct causation, Dr. Grotz and his colleagues are using large datasets and artificial intelligence to analyze these dietary patterns. “What we eat is going to affect our stomach; it’s the first place it goes,” he said.
Questions About Stomach Cancer Procedures
Can patients eat normally after total stomach removal?
Many patients can return to eating three normal-sized meals daily if a J-pouch is constructed during surgery. This reservoir helps hold food and release it slowly, preventing the rapid transit typical of post-gastrectomy digestion.
Why was the proximal gastrectomy procedure abandoned?
Surgeons moved away from the procedure decades ago because patients frequently suffered from severe bile reflux.
Modern variations, such as double-tract reconstruction, now address this issue by reconfiguring the connections between the esophagus and the remaining stomach.
Are there non-surgical options for stomach cancer?
Patients whose cancer is discovered at an early stage may be eligible for endoscopic treatment. This allows physicians to remove the tumor through an endoscope, avoiding the need for conventional surgery and the removal of the stomach.