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Gastrectomy: what the operation involves | CION Cancer Clinics
A gastrectomy removes part or all of the stomach, along with the lymph glands beside it, and joins the food pipe or the remaining stomach to the small bowel so you can eat again. It is done under a general anaesthetic and most people are in hospital for about a week to ten days. This page walks through what is removed, what is joined, and what each day looks like. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What does a gastrectomy actually involve?
- What the surgeon removes, and what is joined back
- What happens from admission to the first meal
- Words you will see on the consent form and the discharge sheet
- What families tell us before this operation, and what is true
- What this page cannot tell you, and what to ask
- Common questions about gastrectomy
The short answer
What does a gastrectomy actually involve?
A gastrectomy removes part or all of the stomach, together with the lymph glands around it, and then joins the food pipe or the remaining stomach to the small bowel so that you can eat again. It is done under a general anaesthetic, through one long cut or several small ones, and most people are in hospital for about a week to ten days.
Why the stomach is removed rather than just the tumour
Stomach cancer spreads along the wall and into the glands beside it before it shows anywhere else. Taking out only the lump would leave those routes behind. So the surgeon removes a wide rim of healthy stomach around the cancer and the fatty apron that carries the glands.
Who this operation is not for
It is not offered when the cancer has already spread to the liver, the lining of the belly or distant glands, because removing the stomach then adds a hard recovery without changing what the cancer does. It is also weighed carefully in anyone whose heart or lungs would struggle with a long anaesthetic.
This page cannot tell you whether surgery is right for you. That is a decision for you and your treating team.Inside the operation
What the surgeon removes, and what is joined back
Every gastrectomy has the same four parts.
The stomach, or part of it
If the cancer sits in the lower half, the lower part is removed and the upper part is kept. If it sits high up near the food pipe, or is spread through the wall, the whole stomach comes out.
The lymph glands around it
The glands along the vessels that feed the stomach are removed in one block, called a D2 dissection. These glands are where stomach cancer first travels, and checking them is how the stage is fixed.
Sometimes also removed
- The fatty apron over the bowel (omentum)
- The spleen, if glands beside it are involved
- A rim of the food pipe, for high tumours
The new join
The cut end of the food pipe, or of the remaining stomach, is stapled to a loop of small bowel, arranged so bile drains lower down and does not wash back up. This join takes longest to heal.
The tubes you wake up with
Usually a drain beside the join, a thin tube through the nose, a catheter, and sometimes a feeding tube into the bowel so you can be fed while the join heals. Each is removed as you recover.
Not sure whether this applies to you?
Ask an oncologistStep by step
What happens from admission to the first meal
Admission and the last checks
You are usually admitted the day before. Blood tests, a chest X-ray and a visit from the anaesthetist happen that evening. You stop eating overnight and are given a drink or a drip so you are not starved going in.
The operation
It takes several hours. The surgeon first looks around the belly to confirm nothing has changed since the scan. Then the stomach is freed, the glands taken, the join made and the drains placed.
The first night
Most people spend it in the ICU or a high-dependency bed. This is routine for a long belly operation. Pain is controlled through a drip or a fine tube in the back.
Getting up, and the first sips
You are helped out of bed and along the corridor from the first or second day, because walking keeps the lungs clear and the bowel moving. Sips of water come first, then clear fluids, then soft food.
Going home
Once you are eating small soft meals, walking on your own and the drain is out. You leave with a written eating plan, a list of warning signs and a date for the tissue report.
On your consent form
Words you will see on the consent form and the discharge sheet
- Subtotal or distal gastrectomy
- The lower part of the stomach is removed and the upper part is kept. You still have a small stomach afterwards.
- Total gastrectomy
- The whole stomach is removed. The food pipe is joined straight to the small bowel.
- D2 lymphadenectomy
- Removal of the glands along the stomach and the main vessels that feed it. The standard extent for stomach cancer.
- Anastomosis
- The new join between two ends of gut. On the discharge sheet, the word "leak" refers to this join not sealing.
- Roux-en-Y
- The way the bowel loop is arranged after the stomach is removed, so that bile drains away from the food pipe rather than into it.
- Frozen section
- A quick tissue check during the operation to confirm the cut edges are clear before the join is made.
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After you go home: the one thing that cannot wait
In the first two weeks after a gastrectomy, a fever, a racing pulse, new or worsening pain in the belly or chest, or breathlessness can mean the join is leaking. This needs the surgical team the same day. Call the ward or the helpline, or go to the nearest emergency department and say you have had stomach surgery. Do not wait for the morning clinic and do not take a painkiller first and see.
Commonly believed
What families tell us before this operation, and what is true
"You cannot live without a stomach."
You can. The stomach stores food and starts digestion, but the small bowel does most of the absorbing. Afterwards you eat smaller meals more often, chew well, and take vitamin B12 by injection for life. It is a different way of eating.
"If they open him up, the cancer will spread in the air."
Cancer does not spread because the belly was opened. Sometimes the surgeon finds spread the scan could not see, and the operation is changed or stopped. That spread was already there. The operation only revealed it.
"Chemotherapy first means the surgeon has given up on surgery."
The opposite. Chemotherapy before surgery is now the usual plan for most stomach cancers that have grown into the wall. It shrinks the tumour and treats cells that may have escaped, and the operation follows a few weeks after the last cycle.
"Keyhole surgery means it was a small cancer."
The size of the cuts says nothing about the stage. The same stomach and the same glands are removed either way. The choice depends on where the tumour sits, your build, and what your centre does routinely. Ask which approach is planned and why.
Being straight with you
What this page cannot tell you, and what to ask
This page cannot tell you which version of the operation you need, how long your own recovery will take, or what the cancer will do afterwards. Those depend on where the tumour sits, what the glands show under the microscope, and how fit you are going in.
What the surgeon weighs
Where the cancer sits and how deep it has gone. Whether the scans show glands or spread beyond the stomach. Your heart and lung fitness, how much weight you have lost recently, and whether chemotherapy first would make the operation safer. Two surgeons may weigh these differently without either being wrong.
Questions worth asking before you sign
How much of the stomach is planned to come out, and could that change during the operation? Will the glands be removed to D2 extent? Is a feeding tube planned? Open or keyhole, and why that choice for you? Who do I call at night if something changes at home? Write the answers down.
If you are still unsure after that conversation, ask for a second opinion. A good surgeon expects the question and is not offended by it.Questions we are asked
Common questions about gastrectomy
How long does the operation take?
Usually several hours from the first cut to the last stitch, and longer if the whole stomach or the spleen is removed. Add the anaesthetic room before and the recovery room after. Families often wait most of a day, so bring food and a charger.
Will I be in the ICU? Does that mean it went badly?
Most people spend the first night in the ICU or a high-dependency bed. It is planned in advance for any long belly operation, so breathing, fluids and pain can be watched closely. It does not mean something went wrong. Most move to the ward the next day.
When will I eat again?
Sips of water first, often within a day or two. Then clear fluids, then soft food, each step only once the team is happy the join is healing. If a feeding tube was placed, liquid feed runs through it meanwhile. You go home on small, soft, frequent meals with a written plan from the dietitian.
How much will it hurt afterwards?
The first few days are sore, especially when you cough or get out of bed. Pain is controlled with a drip you control, or a fine tube in the back, and then tablets. Tell the nurses when it is bad rather than waiting. Good pain control lets you walk, and walking gets you home.
Will I need chemotherapy as well?
Often, yes. For most stomach cancers that have grown into the wall, chemotherapy is given before the operation and again after it. Whether you need it, and which drugs, depends on the stage and on what the removed tissue shows. Your oncologist will discuss it once the tissue report is back.
Can the cancer come back after the stomach is removed?
It can, which is why follow-up visits continue for years and why chemotherapy is often added. How likely that is depends on the stage found at surgery, and no page can give you that figure. Ask your surgeon to go through the tissue report with you.
Open or keyhole: which will I have?
Both remove the same stomach and the same glands. Keyhole means smaller cuts and often a quicker return to walking, but it does not suit every tumour or every patient. Ask your centre which approach they plan for you and why.
Is gastrectomy covered by Aarogyasri or insurance?
Usually, when it is part of an approved cancer treatment plan. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. What you pay yourself is often very different from the sticker figure. Call the helpline with your card details and we will check your cover before you travel.
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Sources
- Cancer Research UK — Surgery for stomach cancer
- Macmillan Cancer Support — Surgery for stomach cancer
- American Cancer Society — Surgery for Stomach Cancer
- National Cancer Institute — Gastric Cancer Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Total vs Subtotal GastrectomyHow the surgeon decides how much stomach to removeD2 Lymph Node Dissection ExplainedWhy the glands come out with the stomachRecovery Timeline After GastrectomyWeek by week, from the ward to normal lifeThe Day of the OperationWhat the family sees and does on the dayDeciding on Cancer SurgeryQuestions to ask before you consent
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