Gastric Cancer Surgery
Total and subtotal gastrectomy, D2 lymph node dissection and Roux-en-Y reconstruction for gastric cancer, with patient-specific planning based on advanced preoperative imaging.
Gastric Cancer Surgery in Tekirdağ
Gastric cancer is among the most common cancers of the digestive system, and surgery is the foundation of curative treatment. Prof. Tamer Sağıroğlu, MD, assesses patients with gastric cancer at his practice in Süleymanpaşa, Tekirdağ; the decision to operate, the extent of surgery and its timing are planned individually.
A successful gastric cancer operation is more than the removal of a tumour. Which vessels supply the tumour, how it relates to neighbouring organs and vessels, and how far lymph node involvement extends are examined in detail with advanced imaging before surgery. That analysis defines the boundaries and the technique of the operation.
Which Patients Can Be Operated On?
There is no single answer to the question "can every patient with gastric cancer have surgery?". Eligibility is determined by assessing:
- Stage of the disease: depth of the tumour in the stomach wall, lymph node involvement and spread to distant organs
- Location of the tumour: cardia, body or antrum involvement changes the extent of the operation
- General condition of the patient: cardiac, pulmonary and renal function, nutritional status
- Response to prior treatment: in some patients, chemotherapy before surgery (neoadjuvant treatment) shrinks the tumour and makes surgery possible
Patients initially assessed as advanced may become candidates for surgery when reconsidered after neoadjuvant treatment. For this reason, patients told that surgery is not possible are advised to obtain a second surgical opinion.
Surgical Techniques
Total Gastrectomy
Removal of the entire stomach. A new digestive pathway is then created between the oesophagus and the small intestine with a Roux-en-Y oesophagojejunostomy. It is preferred for tumours of the upper and middle stomach.
Subtotal Gastrectomy
The part of the stomach containing the tumour is removed and a portion is preserved. It is suitable for tumours of the lower stomach (antrum), and adaptation to eating afterwards is generally easier.
D2 Lymph Node Dissection
One of the steps that most determines the oncological success of gastric cancer surgery: the systematic clearance of the lymph node stations around the stomach and along the major vessels. Removing an adequate number of lymph nodes allows both accurate staging of the disease and a reduction in the risk of recurrence.
The Surgical Pathway
- Assessment: endoscopy and biopsy, computed tomography and, where needed, PET-CT and endoscopic ultrasound for staging
- Multidisciplinary board: a joint decision with medical oncology, radiology and pathology, including whether chemotherapy is required before surgery
- Surgical planning: detailed review of vascular anatomy and definition of resection margins
- Operation: laparoscopic where suitable, open where required
- Pathology and follow-up: examination of surgical margins and lymph nodes, and the decision on additional treatment
Recovery
Patients are usually mobilised on the first day and feeding is resumed in stages. Length of hospital stay depends on the extent of the operation. For patients whose stomach has been removed entirely, small and frequent meals, vitamin B12 monitoring and dietitian support are the foundations of long-term quality of life. Oncological follow-up continues at intervals determined by the pathology result.
Frequently Asked Questions
Mide kanseri olan her hasta ameliyat edilebilir mi?
Hayır. Cerrahi kararı; hastalığın evresi, tümörün yerleşimi, uzak organ yayılımı ve hastanın genel sağlık durumu birlikte değerlendirilerek verilir. Ancak ilk değerlendirmede uygun bulunmayan bazı hastalar, ameliyat öncesi kemoterapi (neoadjuvan tedavi) sonrasında cerrahi şansı kazanabilir. Bu nedenle ikinci bir cerrahi görüş almak önemlidir.
Midenin tamamı alınırsa nasıl beslenilir?
Total gastrektomi sonrası yemek borusu ince bağırsağa birleştirilerek yeni bir sindirim yolu oluşturulur. Hastalar normal gıdaları tüketebilir; ancak porsiyonlar küçülür ve öğün sayısı artar. Diyetisyen eşliğinde düzenlenen az ve sık beslenme programı ile kilo dengesi korunur, B12 vitamini takviyesi düzenli olarak yapılır.
D2 lenf diseksiyonu neden önemlidir?
Mide çevresindeki lenf bezleri kanserin ilk yayılım yollarındandır. D2 diseksiyon, bu lenf istasyonlarının sistematik olarak temizlenmesidir. Hem hastalığın gerçek evresinin belirlenmesini hem de bölgesel nüks riskinin azaltılmasını sağlar; bu nedenle deneyimli merkezlerde uygulanması önerilir.
Mide kanseri ameliyatı laparoskopik yapılabilir mi?
Seçilmiş hastalarda evet. Tümörün evresi, yerleşimi ve hastanın önceki ameliyatları uygunsa laparoskopik yaklaşım tercih edilebilir; daha küçük kesi, daha az ağrı ve daha hızlı iyileşme sağlar. Onkolojik yeterlilikten ödün verilmemesi esastır; gerektiğinde açık cerrahiye geçilir.