What is total gastrectomy?
During the operation, the entire stomach is removed together with the greater and lesser omentum and the regional lymph nodes.
For malignant tumors, the standard is a *D2 lymph node dissection*, which involves removing the lymph nodes in line with international guidelines.
After the stomach is removed, the continuity of the digestive tract is restored by creating a *Roux-en-Y esophagojejunal anastomosis*, which allows food to pass without a gastric reservoir.
Our approach
At MSI, gastric cancer is treated by a multidisciplinary team in line with the guidelines of the *NCCN, ESMO, and the Japanese Gastric Cancer Association*.
Before surgery, the disease is fully staged, including gastroscopy with biopsy, computed tomography, and, when indicated, diagnostic laparoscopy and endoscopic ultrasound. In patients with locally advanced disease, treatment often begins with neoadjuvant chemotherapy.
When technically feasible, we perform total gastrectomy laparoscopically, following the principles of oncological radicality. We pay special attention to the safe creation of the esophagojejunal anastomosis and to fast postoperative recovery according to *ERAS (Enhanced Recovery After Surgery)* protocols.
When is surgery needed?
Total gastrectomy is performed for:
- cancer of the stomach body
- cancer of the upper third of the stomach
- diffuse gastric cancer
- multifocal gastric cancer
- hereditary diffuse gastric cancer (when indicated)
- certain large GISTs or neuroendocrine tumors when organ-preserving surgery is impossible
Indications for surgery
Surgery is recommended for:
- localized or locally advanced gastric cancer
- tumors that cannot be radically removed by subtotal or proximal gastrectomy
- multiple malignant lesions of the stomach
- a high risk of leaving tumor tissue behind with a smaller operation
How is the operation performed?
The procedure is performed under general anesthesia.
After the stomach is mobilized, it is completely removed together with the greater and lesser omentum and a *D2 lymph node dissection. A Roux-en-Y esophagojejunal anastomosis* is then created to restore the continuity of the digestive tract.
The removed specimen is sent for detailed histopathological examination.
Advantages of laparoscopic surgery
- Less surgical trauma
- Less postoperative pain
- Faster return to physical activity
- Lower risk of wound complications
- Shorter hospital stay
- Better cosmetic result
- Oncological radicality in line with international standards
Recovery after surgery
After total gastrectomy, the patient gradually adapts to a new way of digesting food. Eating is resumed with small portions several times a day. Later, most patients return to an active lifestyle but need long-term follow-up, monitoring of nutritional status, and, if necessary, *vitamin B₁₂* replacement therapy, as well as correction of iron or other nutrient deficiencies.
Postoperative care follows *ERAS* principles.
Our advantages
- Specialization in oncological gastric surgery
- D2 lymph node dissection in line with international standards
- Preferential use of the laparoscopic approach
- Modern techniques for creating the esophagojejunal anastomosis
- A multidisciplinary approach to treatment
- Adherence to NCCN, ESMO, and Japanese Gastric Cancer Association guidelines
- Enhanced recovery program (ERAS)
Frequently Asked Questions
Yes. After total gastrectomy, the intestine takes over the role of passing food. Adaptation takes time, but most patients return to an active life.
Yes. After surgery, frequent small meals 5–7 times a day are recommended, with the diet gradually expanded under a doctor's supervision.
Yes. After complete removal of the stomach, its absorption is impaired, so most patients need lifelong vitamin B₁₂ replacement therapy.
Yes. In radical treatment of gastric cancer, D2 lymph node dissection is the international standard and achieves the best oncological results.
It depends on the stage of the disease, the response to preoperative treatment, and the final histopathology report. The further strategy is determined by the multidisciplinary team individually for each patient.