Overview
Removing the lower stomach while preserving function.
Partial gastrectomy removes the lower 60–80% of the stomach while preserving the upper part — the fundus and most of the body. This is the right operation when cancer or other disease is in the lower stomach and clear margins can be achieved without removing the whole organ. The remaining stomach acts as a small reservoir, which makes eating easier than after a total gastrectomy. The cancer cure rate is the same when negative margins and proper lymph node clearance are achieved.
Reconstruction has three main options. A Billroth I connects the remaining stomach directly to the duodenum — the most physiologic option when the stomach pouch is long enough. A Billroth II connects to a loop of jejunum. A Roux-en-Y gastrojejunostomy uses a Y-shaped jejunal limb to prevent bile reflux into the stomach pouch. We choose between them based on tumor location, the length of remaining stomach, and your factors like prior surgery and bile-reflux risk. We discuss the choice with you before surgery.
Who is a candidate?
Patients with lower-stomach (distal or mid-body) cancer that can be resected with clear margins are the largest group. We also operate for refractory peptic ulcer disease that has not responded to medications and endoscopic treatment, for gastric GISTs too large or too central for a wedge resection, and for selected neuroendocrine tumors. Pre-op endoscopy with biopsy, CT staging, and (for cancer) tumor-board review confirm the plan before surgery.
How we perform it
You are asleep under general anesthesia. The robot or laparoscope is positioned through four to five small upper-abdominal ports. We mobilize the stomach by dividing the left and right gastric arteries, the gastroepiploic vessels, and the short gastric vessels as needed. The duodenum is divided just past the pylorus and the stomach is transected at the chosen proximal level, leaving a sufficient pouch. The D2 lymph nodes are taken with the specimen for cancer cases. The chosen reconstruction (Billroth I/II or Roux-en-Y) is then performed with stapled and/or sutured anastomoses.
Recovery
Most patients stay 5–7 days in the hospital. We start clear liquids by day 2 and advance to soft food over one to two weeks. The remaining stomach pouch holds less than a full stomach, so smaller more frequent meals are needed at first. By 3 months most patients are eating most normal foods. Weight loss of 10–15% in the first 3 months is common; weight stabilizes by 6 months. Iron, B12, and vitamin D are followed at each visit.
Why Florida Surgical
Dr. Shaw is fellowship-trained in surgical oncology and HPB. We perform partial gastrectomy with the same oncologic discipline as a total gastrectomy — D2 lymphadenectomy, negative margins, careful anastomosis — and use the robot whenever it gives a precision advantage. Each cancer case goes to tumor board and the surgeon who consults is the surgeon who operates and follows you afterwards.
Frequently asked questions
How is this different from total gastrectomy?
Partial gastrectomy keeps the upper part of the stomach (the fundus and most of the body) and removes the lower 60–80%. Patients tolerate eating better than after total gastrectomy because the remaining pouch acts as a small reservoir. For lower-stomach cancers, the cancer cure rate is the same when negative margins and proper lymphadenectomy are achieved.
What reconstruction options are there?
Three main reconstructions: Billroth I (the stomach is connected directly to the duodenum), Billroth II (the stomach is connected to a loop of jejunum), and Roux-en-Y gastrojejunostomy (with a Y-shaped jejunal limb to prevent bile reflux). The choice depends on tumor location, length of remaining stomach, and patient factors.
Can it be done robotically or laparoscopically?
Yes, in most selected cases. Minimally invasive partial gastrectomy is well established and we use the robot when it gives a precision advantage for dissection and anastomosis. The oncologic rules (margins, D2 lymphadenectomy) apply the same regardless of approach.
Will I lose weight after surgery?
Most patients lose 10–15% of body weight in the first 3 months, then weight stabilizes. Eating smaller, more frequent meals is the rule, and many patients adapt within a few months. Our team includes a nutritionist who works with you from pre-op through recovery.
What are the long-term concerns?
Iron-deficiency anemia, vitamin B12 deficiency, calcium/vitamin D deficiency, and dumping syndrome (sweating, lightheadedness after meals) are the main long-term issues. Most are well controlled by diet adjustments and supplements. We follow these on every visit.