Overview
Removing the distal half for lower-stomach disease.
Distal gastrectomy removes roughly the distal half of the stomach — the antrum, the pylorus, and the lower body — with a healthy proximal margin and the appropriate lymph nodes. It is the preferred operation for distal gastric cancer that can be cleared with a 4–5 cm proximal margin, leaving the upper stomach (fundus and proximal body) intact. Preserving the upper stomach gives a better functional result than a total gastrectomy — patients eat more easily, gain weight back faster, and avoid the obligate B12 deficiency of a no-stomach state.
For cancer, we perform a D2 lymphadenectomy — the systematic removal of nodes along the common hepatic, left gastric, splenic, and celiac arteries. This is the standard of care worldwide and is associated with improved long-term outcomes when performed by experienced teams. Reconstruction is most often Billroth II (loop gastrojejunostomy) or Roux-en-Y gastrojejunostomy. The choice depends on the size of the remaining stomach pouch and on minimizing bile-reflux risk.
Who is a candidate?
Patients with distal or distal-body gastric cancer where a clear proximal margin (typically 4–5 cm) can be achieved are the largest group. Selected GISTs of the lower stomach and certain neuroendocrine tumors are also indications. For benign disease, patients with severely deformed antrum from chronic ulcers or with refractory gastric outlet obstruction may be candidates. We use endoscopy with multiple biopsies, CT staging, and tumor-board review to confirm the plan before surgery.
How we perform it
You are asleep under general anesthesia. Four to five small ports for the laparoscope or robot are placed in the upper abdomen. We mobilize the stomach by dividing the right gastric and right gastroepiploic arteries near their origin (to take the D2 nodes with them), and divide the duodenum just past the pylorus. The stomach is transected at the appropriate proximal level using staplers, taking the D2 lymph nodes with the specimen. Reconstruction is then performed — most often a Billroth II antecolic loop gastrojejunostomy or a Roux-en-Y gastrojejunostomy.
Recovery
Most patients stay 4–6 days in the hospital. We start clear liquids on day 1 or 2, advance to a soft diet over the first one to two weeks, and most patients return to work and exercise in 4–6 weeks. The eating pattern is small frequent meals at first, gradually returning to normal-sized meals over months. Weight loss of 5–10% is expected in the first 3 months and stabilizes by 6 months. Iron and B12 are followed at each visit.
Why Florida Surgical
Dr. Shaw is fellowship-trained in surgical oncology and HPB. We perform distal gastrectomy with full D2 lymphadenectomy as a standard, and use the robot whenever it gives a precision advantage for nodal dissection. Every gastric cancer is reviewed at multidisciplinary tumor board so that the operation is timed correctly with neoadjuvant and adjuvant therapy. The surgeon who consults is the surgeon who operates and follows you long-term.
Frequently asked questions
How is distal gastrectomy different from partial gastrectomy?
Distal gastrectomy is a specific type of partial gastrectomy that removes about the distal half of the stomach. Partial gastrectomy is a more general term that can mean anywhere from 60% to 80% of the stomach removed. We use the term distal gastrectomy when the operation is specifically focused on the lower half.
Is it different from antrectomy?
Yes. Antrectomy removes only the antrum (the very bottom of the stomach). Distal gastrectomy removes the antrum plus the lower body. For cancer, we usually need at least a distal gastrectomy because antrectomy alone does not give enough margin or lymph nodes.
Can it be done robotically?
Yes — distal gastrectomy is one of the operations where the robot offers a clear advantage for precise dissection of the lymph nodes around the pancreas and for hand-sewing the anastomosis when needed. Laparoscopic distal gastrectomy is also well established.
Will eating change?
Yes, in the first weeks. The stomach pouch is smaller, so meals need to be smaller and more frequent. Most patients adapt over 2–3 months and can eat most foods. We have a nutritionist who works with every patient through recovery.
What are the risks?
Bleeding, anastomotic leak, infection, blood clots, and gastroparesis (delayed stomach emptying) are the main risks. The leak rate is low — typically 2–3% in experienced centers — and most leaks are managed without re-operation.