Advances in cancer treatment are reshaping approaches to stomach cancer surgery, according to Travis Grotz, M.D., a Mayo Clinic surgical oncologist. Progress involves either introducing entirely new techniques or refining older methods with modern improvements and resources.
Both surgeries take place during stomach cancer operations, with doctors modifying a pouch used for colorectal procedures and bringing back a procedure largely abandoned years ago. The aim is to manage stomach cancer while prioritizing how patients eat, heal, and live afterwards.
New Surgical Approaches
For tumors in the upper stomach area, doctors previously often did a proximal gastrectomy, removing the top section of the stomach and joining the rest directly to the esophagus. But this surgery often caused bad bile reflux, harming patients’ quality of life.
Now, Mayo Clinic doctors use a method called double-tract reconstruction to alter how the remaining stomach, esophagus, and intestine are linked, helping keep some of the stomach and lower reflux. This method lets surgeons remove enough tissue to treat the cancer while keeping part of the stomach, with reflux occurring roughly 5% of the time.
A concept from colorectal surgery might also help patients eat more normally. Doctors are adopting a familiar idea from that field: altering the small intestine to create a J-pouch, a new storage area that does the job the stomach used to do. This pouch holds food for about 90 minutes before releasing it slowly, making a big difference in daily living.
Dr. Grotz estimates that more than 80% of patients with a pouch can return to eating roughly three normal-sized meals a day. The goal is to help patients return to a full and meaningful life after surgery, with the ability to eat normally being a key part of that.
Changes in Stomach Cancer
Stomach cancer itself is also changing, with the disease being diagnosed more often in younger people and in different parts of the stomach than it was in the past. Dr. Grotz states that stomach cancers in the U.S. are increasingly being found in younger people, and researchers are trying to figure out why.
One area of study is whether greater consumption of ultraprocessed foods could be contributing to the increase in early-onset stomach cancer. Dr. Grotz cautions that current evidence shows an association, not proof that these foods cause stomach cancer, but notes that the question deserves particular attention because today’s younger adults have been exposed to ultraprocessed foods much earlier in life than previous generations were.
The profile of stomach cancer in the U.S. has changed, with physicians seeing more proximal and diffuse stomach cancers, including cancers in younger adults. Researchers are using large datasets and artificial intelligence to investigate the relationships between ultraprocessed foods and stomach cancer further.
For patients, the improvements in stomach cancer treatment can result in something seemingly simple: treating the cancer while keeping as much normal life as possible. Dr. Grotz says the goal is not just to do the biggest possible operation, but to provide treatment tailored to the individual patient, with surgery being just one part of that treatment.
Stomach cancer found early may not require traditional surgery, with some patients being able to be treated through an endoscope rather than conventional surgery. This procedure requires specialized expertise and allows physicians to remove the cancer through an endoscope without removing the stomach, with Dr. Grotz saying that the expertise can matter when patients are considering where to seek care.
Minimally invasive and robotic approaches can reduce the physical burden of treatment for patients who need surgery. Chemotherapy, immunotherapy, and surgery are increasingly used together, with the sequence tailored to the individual patient.
Even some patients whose cancer has spread beyond the stomach may be considered for surgery after responding well to systemic treatment, as surgery is a great consolidative therapy.