Stomach cancer surgery

Stomach cancer surgery removes cancerous stomach tissue. Removing lymph nodes during the operation also helps assess how far the cancer has spread. A fluorescent dye called indocyanine green can help surgeons see lymph nodes, but fluorescence alone can miss nodes containing cancer. In a 2025 review combining stomach and oesophageal cancer surgery, this technique was not reliable enough to be the sole guide for identifying cancer-containing nodes.

The aim of surgery matters when discussing treatment. An operation intended to cure the cancer is different from an operation undertaken with a palliative aim rather than an expectation of cure. A 2024 Swedish study found that advanced disease and emergency surgery were associated with a greater likelihood that the surgeon would judge removal to have limited potential for cure. Discussion by a team of different cancer specialists and chemotherapy before surgery were associated with a lower likelihood of that assessment.

Choices about surgical equipment are separate from choices about cancer treatment. In a 2016 review of three randomized trials involving 335 patients having stomach cancer surgery with curative intent, LigaSure, a device that seals blood vessels, showed no statistically significant advantage over conventional surgery in operating time, blood loss or surgical complications. This comparison concerns a surgical tool, not whether an operation is preferable to a non-surgical treatment.

Long-term results depend on the patients and treatment setting being studied. A 2019 analysis followed 494 patients treated in Dutch hospitals within a trial of chemotherapy before surgery, followed by stomach removal with curative intent and further chemotherapy or chemoradiotherapy. Median follow-up was five years. The estimated proportion alive at five years was 59.2% in hospitals performing at least 21 stomach cancer operations a year and 46.1% in hospitals performing 1–20 a year. Hospital volume was associated with survival; patients were not randomly assigned to high- or low-volume hospitals, so these figures do not prove that volume alone caused the difference or predict an individual’s outcome.

One serious complication is leakage from the closed end of the duodenum, the first part of the small intestine. A 2026 study of stomach cancer operations performed during 2019–2022 at 24 high-volume European centres found this postoperative complication in 64 of 2,422 eligible patients (2.6%). Among the 64 patients who developed the leak, 11 died within 90 days (17.2%); that percentage applies to patients with this complication, not to everyone undergoing surgery. Nine patients were managed without an operation or a radiology procedure, 16 received treatment through interventional radiology, and 39 needed another operation for an acute presentation or after other treatment failed.

Physical condition before surgery also matters. A 2022 review of 20 cohort studies involving 7,615 patients linked sarcopenia, or muscle loss, before stomach cancer surgery with more postoperative complications, including serious complications and pneumonia.

Early recovery includes managing pain. In a 2025 study of 108 patients after stomach cancer surgery, both treatment groups received a patient-controlled pain-relief pump and an abdominal nerve block. The 54 patients receiving nalbuphine had lower pain scores at rest and during activity at 6, 12, 24 and 48 hours than the 54 receiving sufentanil.

Nutrition has also been studied during chemotherapy after surgery. A 2024 randomized trial compared 53 patients receiving an additional specialized nutrient preparation with 53 receiving a regular diet alongside chemotherapy. After one chemotherapy cycle, the additional-nutrition group had better grip strength and several blood markers of nutritional status. Differences in weight and body fat were not statistically significant. These short-term findings concern support during chemotherapy, rather than a timetable for recovery or evidence of a long-term survival benefit.