Why is a partial gastrectomy performed?
A partial gastrectomy is most often performed to treat stomach cancer. A partial gastrectomy may be indicated in the following situations:
- Subtotal gastrectomy of the lower stomach is performed for cancer in the antrum and pylorus (the lower parts of stomach attached to the small bowel).
- Total gastrectomy is performed for cancer in the upper or main part of the stomach.
- Partial gastrectomy of the upper stomach and partial esophagectomy (removal of esophagus) is performed for cancer in the esophagogastric junction (the place where esophagus is attached to the stomach).
Recurrent ulcer disease: Recurrence of ulcers have become uncommon, with advancement in treatment of ulcers with medications for acid reduction, and eradication of Helicobacter pylori (a bacteria species that causes ulcers). Partial gastrectomy is now a rare treatment for ulcer.
Large duodenal perforations: A partial gastrectomy of the lower stomach may be performed when there are large perforations in the duodenum that cannot be patched. The perforated part of the duodenum is removed and the remaining portion is connected to the main part of the stomach.
Bleeding gastric ulcers: Partial gastrectomy may be performed when there are bleeding ulcers in the stomach.
Gastrointestinal stromal tumors: Partial gastrectomy may be required to remove large stromal tumors (gastrointestinal tract tumors that may be benign or malignant) in the stomach.
Corrosive stricture of the stomach: Partial gastrectomy is performed to treat strictures caused primarily in the esophagus and the stomach after ingestion of any corrosive substance.
Morbid obesity: A subtotal gastrectomy, also known as a sleeve gastrectomy, is performed to reduce the size of the stomach in people with life-threatening obesity. A small pouch is left remaining which is connected to the duodenum or jejunum.
Partial gastrectomy is performed with caution in patients with
- Hypoproteinemia (low protein levels in blood)
- Hypokalemia (low potassium in blood)
- Severe comorbidities (co-existence of more than one disorder)
- Severe ascites (fluid in the abdomen)
- Metastasized (spread from original site) cancer
- Cancer in the peritoneum (abdominal membrane)
- Tumors fixed to the adjacent organs such as liver or pancreas
- Adhesions from previous abdominal surgeries
The patient may have to undergo corrective treatments where possible, prior to surgery. In some patients with metastasized cancer, a partial gastrectomy may be performed as a palliative measure to relieve symptoms.
Patients with malignancy may undergo an exploratory laparoscopy before a planned partial gastrectomy. The reason is to assess the stage of the cancer, and presence of metastasis in the peritoneum or liver.