ENSomeone handed a report saying “gastric cancer” almost always hears “operation” and almost never knows what lies behind it: part of the stomach or all of it, now or after chemotherapy, through a cut or small ports.
This page on stomach cancer surgery in Germany answers them in order: who is offered an operation, which operations German hospitals do, what is always checked beforehand and what recovery looks like. For the disease as a whole, see stomach cancer treatment in Germany.
When the operation is done and when it is postponed
Surgery is done when the tumour can be removed whole, with a margin of healthy tissue and the nearby lymph nodes; this is what operability means. A tumour board decides it, not the surgeon alone: an oncologist, a radiologist and a pathologist review the case.
Usually the operation does not come first. If the tumour has grown deeper than the surface layers of the stomach wall, treatment generally starts with chemotherapy, to shrink the tumour and show how it responds to drugs; the course normally continues after surgery. The oncologist chooses the drugs.
Surgery is declined or postponed if the cancer has spread across the peritoneum, the thin lining of the abdomen, if there are distant metastases or if the patient’s general condition is poor. Drug treatment is then discussed, sometimes with an operation to relieve symptoms such as a blocked stomach outlet: a separate conversation, see stage 4 stomach cancer.
Which operations are done for stomach cancer
The two main operations are removing part of the stomach (subtotal resection) when the tumour lies in the lower or middle third, and removing all of it (gastrectomy) when it lies high or has spread through the wall. Both remove the surrounding lymph nodes, an extended lymph node dissection, standard in Germany once the tumour has grown into the wall.
Early tumours that have not left the lining, the stomach’s inner layer, are sometimes removed from the inside through the gastroscope, keeping the stomach whole. This depends on size, depth and cell type, and the pathologist confirms the decision on the removed piece.
Technically, surgery is increasingly laparoscopic, through small ports instead of a large incision: less pain, and patients are up sooner. Some departments use a surgical robot through the same ports. The route is not the patient’s choice; it depends on where the tumour sits, its stage and the department’s experience.
What is always done before the operation
Staging always comes first: how deep the tumour has grown and whether it has spread. It takes a gastroscopy with biopsy (see gastroscopy in Germany), CT of the chest and abdomen and an endoscopic ultrasound for depth. If the tumour is deep or there is doubt, a diagnostic laparoscopy is added: a short look inside the abdomen through small ports that sometimes changes the whole plan.
Before a major operation the person is assessed too: heart, lungs, nutrition and weight. Weight lost before stomach surgery is a problem in itself, so German departments start nutritional support beforehand, not afterwards, as the German clinical guideline on gastric cancer advises.
Then comes a second look at the slides and images: often a German pathologist’s review of the biopsy pins down the tumour type and the features that decide the choice of drugs, so the hospital asks for the slides in advance, before the trip.
After the operation: recovery and life without part of the stomach
Recovery is gradual: the first days bring pain control, early movement and a slow return to eating. How long each step takes depends on the operation and the patient; the surgeon sets the day of discharge.
After a total gastrectomy the oesophagus is joined directly to a loop of small bowel, so food no longer has a place to wait. Habits change: small portions many times a day, eaten slowly, with drinks apart from meals. Vitamin B12 and iron need checking for life, and B12 has to be replaced. People live with this, but eating has to be rebuilt.
Then come follow-up visits, continued chemotherapy if it was planned, and oncological rehabilitation, which many patients start straight after discharge.
Where stomach cancer is operated on in Germany
Stomach cancer is operated on in abdominal surgery departments of large hospitals and certified centres for digestive tract tumours. AlenMed’s partners include the Rechts der Isar hospital in Munich, where Prof. Helmut Friess, a specialist in pancreatic and abdominal surgery including the oesophagus, liver and bowel, heads the surgical clinic. At the Israelitisches Krankenhaus in Hamburg, the surgical clinic and visceral oncology centre are led by Prof. Jan-Hendrik Egberts.
For the patient, this means the surgeon, oncologist, endoscopist and pathologist meet as one board in one institution, so decisions take days, not months. The final plan and timing come from the hospital.
Frequently asked questions
Is chemotherapy always given before stomach cancer surgery?
No. An early tumour confined to the lining is removed through the gastroscope or operated on straight away. If the tumour has grown deep into the wall or lymph nodes are involved, chemotherapy is given both before and after the operation. At an intermediate depth, the tumour board decides.
Can stomach cancer be operated on through small ports?
Often, yes. For early tumours, the German guideline considers laparoscopic removal of part or all of the stomach no less reliable than open surgery, with faster recovery. For more advanced tumours, especially after chemotherapy, this is still being studied, and the surgeon may prefer an incision.
Can you live a normal life without a stomach?
Yes, but eating has to change. Food passes from the oesophagus straight into the bowel, so small portions, slow eating and drinking between meals help. Vitamin B12 is replaced for life, and weight and iron stores are checked regularly. A dietitian helps, starting in hospital.
How AlenMed arranges the operation
AlenMed passes your documents to the department: the gastroscopy report with the biopsy, slides or blocks for review, CT images on a disc, laboratory results, letters on previous illnesses and the list of medicines. The department replies whether it accepts you, whether chemotherapy comes first and how many days the trip takes; then come a written estimate, a visa invitation, back-to-back appointments and an interpreter in the hospital (see arranging treatment in Germany).
Plan for a companion, spare time after discharge, an agreement with your doctor at home on continuing treatment, and a translation of the discharge report.
This material is for information only and is not an offer. The surgeon decides the extent of the operation in person after examination and work-up.
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