Stomach Cancer Treatment

The stomach is one of the key organs in the digestive tract. It is a muscular pouch located between the esophagus and the duodenum. Digestion that begins in the mouth continues in the stomach, where food particles are broken down by gastric juices into a semi-liquid form and then passed into the small intestine.

Conditions that may require partial or total gastrectomy include:

• Stomach cancer

• Bleeding ulcers that cannot be managed conservatively

• Perforation of the stomach wall

• Benign polyps that cannot be removed endoscopically

The leading method for stomach oncology treatment in Israel is surgery — the removal of the tumor and regional lymph nodes. Chemotherapy is usually administered before surgery (neoadjuvant) or after. Radiation therapy is used occasionally.

In most cases, tumor removal requires resection of part or all of the stomach. There are several types of stomach resection:

• Total gastrectomy (complete removal)

• Subtotal distal gastrectomy (removal of the portion connecting to the intestines)

• Subtotal proximal gastrectomy (removal of the portion connecting to the esophagus)

When performing gastrectomy due to adenocarcinoma, an extended lymph node dissection (D2) is typically carried out to remove lymph nodes that drain the stomach.

Adenocarcinoma is the most common type of stomach tumor. Despite its malignant and aggressive nature, surgery offers the only real chance of a cure. When diagnosed early, five-year survival rates can reach up to 90%.

After surgery, the digestive tract is reconstructed to maintain normal intestinal function. Following total or distal gastrectomy, the remaining part of the gastrointestinal tract is connected to the small intestine. In proximal resections, the stomach stump is joined to the esophagus.

In most cases, gastrectomy for gastric cancer treatment in Israel is performed via open surgery, requiring a vertical or transverse abdominal incision. In selected cases — particularly benign conditions or gastrointestinal stromal tumors (GISTs) — a laparoscopic (minimally invasive) approach is used, involving small incisions and a camera.

Outcomes depend on the indication, stage of cancer, and the patient’s overall condition. When gastric cancer is caught early, five-year survival rates are 80–90%. In advanced stages, survival rates drop to 10–30% for adenocarcinoma and 40–60% for lymphomas.

Quality of life after surgery is typically acceptable. Most patients return to a normal diet and maintain a healthy appetite.

There are various techniques for subtotal or total gastrectomy, chosen based on the patient’s anatomy, disease extent, and the surgeon’s experience. All procedures are performed under general anesthesia.

Surgery usually begins with a laparoscopic inspection of the abdominal cavity to check for metastases. A camera and instruments are inserted through small incisions. If suspicious lesions are found, a quick biopsy is done. If metastases to the liver or peritoneum are confirmed, curative surgery is not performed.

In some cases of advanced, inoperable stomach cancer, a bypass between the stomach and small intestine is created to alleviate symptoms and improve quality of life — although this does not cure the disease.

In laparoscopic surgery, a small incision is made (often near the navel), through which a camera is inserted. The surgical team views the procedure on high-resolution monitors. The surgeon removes the tumor and reconstructs the GI tract similarly to open surgery. Before closing, the abdominal cavity is checked again. Incisions are then stitched or sealed with surgical glue. Drainage may be placed if needed.

Occasionally, the procedure must be converted to open surgery due to technical difficulties (e.g., scar tissue from previous operations or anatomical limitations). This is not considered a complication but a safety precaution.

Patients who have had prior abdominal surgeries may be scheduled for open surgery from the outset.

Both open and laparoscopic stomach surgeries are performed under general anesthesia. The anesthesiologist continuously monitors the patient to ensure they remain in a deep sleep with complete muscle relaxation and no sensation.

Anesthetic drugs are delivered intravenously through a saline drip. The patient quickly falls asleep and is unaware of the procedure.

Once surgery is complete, the anesthesiologist stops the medication, and the patient awakens in a post-op recovery unit under close monitoring.

Approximately 2.5 to 3 hours.

After surgery — whether open or laparoscopic — the patient spends about two hours in recovery, then is transferred to the surgical ward. Only in rare cases (e.g., complications or poor general condition) is ICU care required.

Within hours of being admitted to the ward, the patient is encouraged to sit up. Painkillers and antibiotics are given as needed, usually intravenously.

Most patients can get out of bed the next day. Early mobility is encouraged, as it supports faster healing, improves bowel function, and prevents complications like blood clots and pneumonia. Breathing exercises and gentle leg movement are also recommended, assisted by a physiotherapist.

A personalized nutrition plan is created for each patient. Vitamin supplementation is typically necessary.

After total gastrectomy, small frequent meals are advised. The diet should be high in protein and low in sugars to avoid dumping syndrome. Vitamin B12 injections will be needed for life, as this vitamin is only absorbed in the stomach. Even after partial gastrectomy, absorption may be impaired, so levels should be monitored regularly and supplemented if needed.

Dietary changes may be temporary or permanent.

Hospital stay is usually 7–10 days.

Despite the central role of the stomach in digestion, patients can live normal lives even after a significant part of it is removed. The remaining portion or the reconstructed tract adapts over time.

Recovery takes several weeks to months. Those with comorbidities or receiving chemotherapy may require more time. During the first 6–8 weeks post-op, patients should avoid physical strain, lifting, and sexual activity. Gentle daily movement is encouraged.

If weakness or dizziness occurs, driving should be avoided until symptoms subside. Medical leave is typically 4–6 weeks.

About two weeks post-surgery, the patient returns for a follow-up with the surgeon. It’s important to discuss new symptoms, concerns, or discomfort.

Contact your doctor or nurse immediately if you experience:

• Fever above 38°C

• Chills

• Vomiting

• Urinary retention

• Bleeding or discharge at the surgical site

• Severe abdominal bloating or pain

• Persistent nausea or vomiting

• Inability to eat or drink

Patients who undergo gastrectomy for cancer must continue treatment and monitoring at an oncology center.

Patients looking to treat stomach cancer without queues or delays can contact Ichilov Hospital’s international department:

• Email: medtour@tlvmc.gov.il

• Submit a request on this page in the form below

You’ll receive a reply within 24–48 hours, including an evaluation of your case and a preliminary treatment plan. This fast process helps you treat stomach cancer without waiting, reduce unnecessary tests, and begin stomach cancer treatment in Israel without delay.