PORTER ROBOTICS INSTITUTE FACT SHEET
Condition: Gastric (Stomach) Cancer
Robotic Procedure: Gastrectomy (Subtotal or Total)
If you have gastric cancer that requires surgery, a robotic procedure called a subtotal or total
gastrectomy may be the most effective surgical procedure for you. Robotic surgery offers you the
potential for less bleeding, a shorter recovery time and less pain. Learn more about gastric cancer
and robotic subtotal or total gastrectomy below.
Gastric Cancer
Definition
Gastric cancer is cancer that starts in the stomach. Your stomach is located in the upper abdomen
and is about the size of 2 large fists. Its primary function is to help food digest before it moves on
to the small intestine. Stomach cancer, sometimes called gastric cancer, is a disease in which cells
grow uncontrollably and form a tumor in the stomach. Stomach cancer is one of the most common
cancers worldwide but it is decreasing in the Western world, with an estimated 21,130 diagnosed
in 2009.
Causes
Several different types of cancer can occur in the stomach. The most common type is called
adenocarcinoma, which starts from one of the common cell types found in the lining of the
stomach. There are several types of adenocarcinoma. Because other types of gastric cancer occur
much less frequently, this fact sheet focuses on adenocarcinoma of the stomach.
Adenocarcinoma of the stomach is a common cancer of the digestive tract worldwide, although it
is relatively uncommon in the United States. It occurs most frequently in men over 40 years old.
This form of gastric cancer is extremely common in Japan, Chile, and Iceland. The rate of most
types of gastric adenocarcinoma in the United States has declined over the years. Experts think the
decrease may be related to the reduced intake of salted, cured, and smoked foods.
Diagnosis is often delayed because symptoms may not occur in the early stages of the disease, or
because patients self-treat symptoms that may be common to other, less serious gastrointestinal
disorders (bloating, gas, heartburn, and a sense of fullness).
Risk factors associated with gastric cancer are a family history of gastric cancer, Helicobacter
pylori infection, blood type A, smoking, a history of pernicious anemia, a history of chronic
atrophic gastritis, and a prior history of an adenomatous gastric polyp larger than 2 centimeters.
Symptoms
Stomach cancer is hard to diagnose in its early stages. Indigestion and stomach discomfort can be
symptoms of early stomach cancer, but other conditions can cause the same symptoms. In
advanced cases of this disease, there may be:
• Abdominal pain
• Dark stools, an indication of blood in your stool
• Difficulty swallowing, particularly difficulty that increases over time
• Excessive belching
• General decline in health
• Loss of appetite
• Nausea and vomiting
• Premature abdominal fullness after meals
• Unintentional weight loss
• Vague abdominal fullness
• Vomiting blood
• Weakness or fatigue
Diagnosis
The following tests can help diagnose gastric cancer:
• Complete blood count (CBC) to check for anemia
• Esophagogastroduodenoscopy (EGD) with biopsy
• Stool test to check for blood in the stools
• Upper GI series
Treatment
Regardless of what stage of stomach cancer you have, treatment is available. The main treatments
for stomach cancer are surgery, chemotherapy, and radiation therapy. More than one treatment
method is often used to treat this disease. Stomach cancer can be difficult to treat because it is
often found in later stages.
The choice of treatment you receive depends on many factors. The location and the stage (extent)
of the tumor are very important. In choosing your treatment plan, you and your cancer care team
will also take your age, general health, and personal preferences into account.
Before starting treatment, it is important to understand the goal of your treatment - whether it is to
cure your cancer or to relieve symptoms. If the goal of your treatment is to cure the cancer, you
will also receive treatment to relieve common side effects that may be caused by your treatment.
If a cure is not possible, treatment is aimed at relieving symptoms, such as trouble eating, pain, or
bleeding.
Chemotherapy: Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or
given by mouth as pills. These drugs enter the bloodstream and reach all areas of the body, making
this treatment useful for cancer that has spread to organs beyond the stomach.
Often for stomach cancer, chemotherapy is given along with radiation therapy after surgery. This
combination is called chemo-radiation. It may delay the cancer from coming back and extend the
life span of people with less advanced stomach cancer. This may be especially helpful for cancers
that could not be removed completely by surgery.
Radiation: Radiation therapy uses high-energy rays or particles to kill cancer cells in a specific
area of the body. External beam radiation therapy is the type of radiation therapy often used to
treat stomach cancer. This treatment focuses the radiation on the cancer from a machine outside
the body. Having this type of radiation therapy is like having an x-ray, except each treatment lasts
longer, and the patient usually receives five treatments per week over a period of weeks or months.
Surgery: There are three kinds of surgery that may be used to treat stomach cancer, including
endoscopic mucosal resection, subtotal gastrectomy and total gastrectomy (see detailed
descriptions below).
Surgery may be used to remove the cancer and part or all of the stomach, depending on the type
and stage of the cancer. Surgical removal of the stomach (gastrectomy) is the only curative
treatment. Radiation therapy and chemotherapy may be beneficial. A recent study showed that for
many patients, chemotherapy and radiation therapy given after surgery improve the chance of a
cure. For patients in whom surgery is not an option, chemotherapy or radiation can improve
symptoms and may prolong survival but will likely not cure the cancer. For some patients, a
surgical bypass procedure may provide relief of symptoms. If a patient’s cancer is in the early to
moderate stage and is healthy enough, an attempt should be made to treat the cancer with surgery.
Some patients with stage IV cancer that has not spread to distant sites may also benefit from
surgery. Even when the cancer is too widespread to be removed completely by surgery, patients
may be helped from surgery because it may help prevent bleeding from the tumor or prevent the
stomach from being blocked by tumor growth.
Endoscopic mucosal resection
In this procedure, the cancer is removed through an endoscope - a long, flexible tube passed down
the throat and into the stomach. This procedure is only done for certain very early stage cancers,
where the chance of the tumor penetrating through the wall or spreading to the lymph nodes is
very low.
Traditional Gastrectomy (Subtotal/Total)
Gastrectomy is surgery to remove all or part of your stomach and sometimes other organs. There
are two types of gastrectomy, subtotal and total.
A subtotal gastrectomy involves removal of only part of the stomach, sometimes along with part
of the esophagus or the beginning of the small intestine (the duodenum). Nearby lymph nodes are
also removed. The remaining section of stomach is then reattached. The surgeon will try to leave
behind as much normal stomach as possible. Eating is much easier if only part of the stomach is
removed instead of the entire stomach.
A subtotal gastrectomy is often recommended if the cancer is only in the lower or the upper part of
the stomach. A traditional subtotal gastrectomy is performed through an "open" surgical technique,
which requires a wide incision to open the abdomen.
A total gastrectomy is the surgical removal of the entire stomach, nearby lymph nodes, and
possible removal of the spleen and parts of the esophagus, intestines, pancreas, and other nearby
organs. A traditional total gastrectomy is performed through an "open" surgical technique, which
requires a wide incision to open the abdomen.
If you have a total gastrectomy, the surgeon will make a new "stomach" out of intestinal tissue.
Usually the end of the esophagus is attached to part of the small intestine. This can make room for
food to be stored before moving down the intestinal tract, and will allow you to eat some food
before getting full. But, people who have a total gastrectomy can only eat a small amount of food
at a time. Because of this, they must eat more often.
Your doctor will probably recommend a total gastrectomy if the cancer has spread throughout the
stomach. It is also often advised if the cancer is in the upper part of the stomach, near the
esophagus. This operation is viewed as the most realistic chance to cure stomach cancer.
Note: Lymph node removal is a very important part of both subtotal and total gastrectomy
procedures. Many doctors feel that the success of the surgery is directly related to how many
lymph nodes the surgeon removes. In the United States, it is recommended that at least 15 nodes
be removed. Surgeons in Japan have had very high success rates by doing a more extensive
removal of lymph nodes near the cancer. Stomach cancer is much more common in Japan, but the
disease is often caught in early stages since patients are screened for stomach cancer.
Robotic Gastrectomy (Subtotal/Total)
If your doctor recommends surgery to treat gastric cancer, you may be a candidate for a safe,
effective and minimally invasive procedure – da Vinci® Surgery – called a gastrectomy (subtotal
or total) to surgically remove the cancer.
Unlike traditional "open" surgery, which requires a wide incision to open the abdomen, da Vinci
surgery only requires small incisions to introduce miniaturized wristed instruments and a high-
definition 3D camera. Seated comfortably at the console, your surgeon views a magnified, high-
resolution 3D image of the surgical site. At the same time, state-of-the-art robotic and computer
technologies scale, filter and seamlessly translate your surgeon's hand movements into precise
micro-movements of the instruments.
In the case of a subtotal gastrectomy your surgeon will use the robot’s miniaturized wristed
instruments and enhanced visualization to carefully remove part of your stomach, sometimes along
with part of the esophagus or the beginning of the small intestine (the duodenum). Nearby lymph
nodes are also removed. The remaining section of stomach is then reattached.
In the case of a total gastrectomy your surgeon will use the robot’s miniaturized wristed
instruments and enhanced visualization to carefully remove your entire stomach, nearby lymph
nodes, and possibly your spleen and parts of your esophagus, intestines, pancreas, and other nearby
organs. Your surgeon will then make a new "stomach" out of intestinal tissue.
Robotic gastrectomy (subtotal and total) offers you the potential for numerous benefits over
traditional open surgery, including:
• Shorter, less painful recoveries
• Less risk of infection
• Less blood loss
• A faster return to your everyday activities
• Superior clinical results
As with any surgery, these benefits cannot be guaranteed, as surgery is unique to each patient and
procedure. While both subtotal and total robotic gastrectomies are considered safe and effective,
these procedures may not be appropriate for every individual. Always ask your doctor about all
treatment options, as well as their risks and benefits.
The da Vinci Surgical System is a breakthrough surgical platform that enables surgeons to operate
with unmatched precision, vision and control. By overcoming the limitations of traditional open
surgery, da Vinci is revolutionizing the way both subtotal and total gastrectomies are performed.
The Porter Robotics Institute is one of only a few major medical centers in the United States
performing gastrectomies via the da Vinci Surgical System.
surgone.com