Overview
Removing the whole stomach to cure gastric cancer.
Total gastrectomy is the complete removal of the stomach. We perform it for gastric cancers that are too proximal or too diffuse to be cured by a partial resection, for diffuse-type cancers (linitis plastica), for patients with hereditary diffuse gastric cancer caused by the CDH1 gene mutation, and for selected gastric GISTs and lymphomas. After removing the stomach, the esophagus is reconnected directly to a loop of small intestine (jejunum) using a Roux-en-Y reconstruction, restoring a path for food and preventing bile reflux into the esophagus.
A proper cancer operation also includes a D2 lymphadenectomy — the systematic removal of lymph nodes along the major arteries of the stomach. We perform this routinely. Most patients receive neoadjuvant chemotherapy before surgery, with adjuvant treatment afterward depending on the final pathology. The whole plan is built in multidisciplinary tumor board so that the operation is the centerpiece of a coordinated cancer treatment, not an isolated event.
Who is a candidate?
Patients with gastric cancer that cannot be removed with a partial resection — proximal cancers, diffuse-type cancers, or cancers that involve much of the stomach — are candidates. We also offer prophylactic total gastrectomy to patients with the CDH1 mutation, who carry a lifetime risk of diffuse gastric cancer that approaches 70%. Staging is essential — CT, endoscopic ultrasound, and often staging laparoscopy — to confirm the cancer is resectable for cure before we operate. Nutritional and physical condition must support a major operation.
How we perform it
You are asleep under general anesthesia with an epidural for pain control. We enter the abdomen open or through robotic/laparoscopic ports. The stomach is mobilized away from the spleen, liver, and pancreas. The arteries supplying the stomach (left and right gastric, short gastric, gastroepiploic) are divided and the D2 lymph nodes are taken with the specimen. The duodenum is divided just past the pylorus and the esophagus is divided in the chest at the diaphragm. The Roux limb is created and brought up to the esophagus for the esophagojejunostomy, with the second anastomosis 40–60 cm down.
Recovery
Most patients stay in the hospital 6–8 days. A nasogastric tube may be used briefly. We test the esophagojejunostomy with a contrast study, then advance from clear liquids to pureed food over the first one to two weeks. Eating is permanently different — small frequent meals (5–6 a day), no large drinks with meals, careful protein. Weight loss in the first 3 months is expected; weight stabilizes by 6 months. Lifelong vitamin B12 and a multivitamin are essential.
Why Florida Surgical
Dr. Shaw is fellowship-trained in surgical oncology and HPB. Gastric cancer outcomes are tightly linked to high-volume specialty experience — adequate D2 lymphadenectomy, safe anastomosis, perioperative pathway, and close coordination with medical oncology and nutrition. Every gastric cancer case is presented at multidisciplinary tumor board, and the surgeon who consults is the surgeon who operates and follows you for life — through nutritional adjustments, surveillance imaging, and endoscopy.
Frequently asked questions
Can I live without a stomach?
Yes. After total gastrectomy your esophagus is reconnected directly to your small bowel using a Roux limb. Patients eat smaller, more frequent meals — typically 5–6 small meals a day — and the small bowel adapts to take over storage and absorption. Most patients return to a near-normal lifestyle, with attention to nutrition and B12.
How is the reconstruction done?
We use a Roux-en-Y esophagojejunostomy. The jejunum is divided, the upper end is brought up and connected to the esophagus, and a second connection 40–60 cm down reconnects the duodenal limb so digestive enzymes and bile drain normally. This prevents bile reflux into the esophagus.
Will I need vitamins for life?
Yes. Without a stomach, you cannot absorb vitamin B12 from food and you need lifelong B12 injections or high-dose oral supplements. Iron, calcium, vitamin D, and a multivitamin are also recommended. We coordinate this with your primary care doctor.
Can it be done minimally invasively?
Yes, in selected centers. Robotic and laparoscopic total gastrectomy are options for the right patient, and our team has experience with both. The choice depends on tumor stage, location, body habitus, and prior surgery. We make the decision case by case.
What are the risks?
Total gastrectomy is a major operation with risks of bleeding, anastomotic leak, infection, blood clots, and post-operative complications. The most worrying complication is leak at the esophagojejunostomy. Experienced technique, drains, and a careful post-op pathway keep the rate low.