Dr. Solon Gonçalves Souza Menezes
Professor of Surgery — FAMED UFU · Board certification in Digestive System Surgery (CBCD/AMB) · Robotic Surgery certification (Intuitive / Albert Einstein Hospital) · Practices at UMC and Mater Dei Santa Genoveva Hospitals, Uberlândia-MG · (34) 99341-0915
Stomach cancer is a broad term covering different types of tumors that originate in the organ. The most common is gastric adenocarcinoma, which originates in the cells lining the stomach's mucosa and is among the most common digestive neoplasms diagnosed in Brazil, with higher incidence in men over 50 years of age. Less common types include gastrointestinal stromal tumor (GIST), gastric lymphoma, and neuroendocrine tumors, each with its own biological behavior, workup, and treatment — this page focuses primarily on gastric adenocarcinoma, the most common form of the disease. Factors associated with adenocarcinoma include chronic Helicobacter pylori infection, atrophic gastritis, intestinal metaplasia, family history, smoking, and a diet rich in processed, smoked, or high-salt foods. In early stages, the disease is often asymptomatic or causes only nonspecific epigastric discomfort, which delays diagnosis. Warning signs that warrant medical evaluation include unintentional weight loss, early satiety, persistent epigastric pain, recurrent nausea and vomiting, anemia without an apparent cause, gastrointestinal bleeding (dark stools or vomiting blood), and progressive difficulty swallowing, when the tumor involves the esophagogastric junction.
The diagnosis of stomach cancer is confirmed by upper gastrointestinal endoscopy with biopsy, an examination that allows direct visualization of the lesion and determination of its histological type. Complementary staging is performed with computed tomography of the abdomen and chest, which may include endoscopic ultrasound and, in selected cases, diagnostic laparoscopy to assess peritoneal dissemination. Once the disease stage is defined, oncologic surgery is the mainstay of curative-intent treatment in resectable tumors, with or without perioperative chemotherapy. Surgical planning is conducted by Dr. Solon Gonçalves, a surgeon certified in Oncologic Surgery of the Digestive System by the Brazilian College of Digestive Surgery (Colégio Brasileiro de Cirurgia Digestiva, CBCD) — a society affiliated with the Brazilian Medical Association (Associação Médica Brasileira, AMB) — who takes into account tumor extent, lymph node involvement, and the patient's clinical condition to indicate the most appropriate technique and surgical approach for each case.
Surgical treatment of stomach cancer is individualized according to the location and extent of the tumor. Distal tumors may be treated with subtotal (partial) gastrectomy, preserving part of the organ, while proximal or more extensive lesions indicate total gastrectomy. In both cases, regional D2 lymphadenectomy is performed, with systematic removal of the perigastric lymph nodes and the lymph node chains along the celiac trunk and its branches (left gastric, common hepatic, and splenic arteries), for adequate staging and oncologic control. The surgical approach may be open, laparoscopic, or robotic, depending on tumor and patient characteristics. Reconstruction of digestive continuity is performed with gastrojejunostomy after subtotal gastrectomy, or Roux-en-Y esophagojejunostomy after total gastrectomy. In more advanced stages, perioperative chemotherapy (neoadjuvant and adjuvant) is added, according to a protocol defined jointly with the clinical oncology team.
What to expect before and after surgery.
Preoperative preparation
Preoperative preparation for oncologic gastrectomy generally involves clinical and cardiac evaluation, imaging and laboratory exams for staging and optimizing the patient's health, as well as fasting instructions, medication adjustments, and, when indicated, prior nutritional support. The care team also typically explains the anesthetic and surgical plan individually during the consultations that precede the operation. The exact steps and time needed for this preparation may vary according to disease stage, associated comorbidities, and the chosen surgical approach, and are always defined on a case-by-case basis.
Recovery and postoperative care
Recovery after oncologic gastrectomy typically involves early mobilization, a gradual resumption of oral diet according to individual tolerance, and close monitoring of healing and any complications during hospitalization. Hospital stay and return to daily activities tend to vary according to the extent of resection, the surgical approach used, and each patient's clinical progress. Nutritional adjustments and multidisciplinary follow-up after surgery may also be recommended, always according to the assessment of the responsible medical team.
Common questions about this procedure.
What are the symptoms of stomach cancer?+
In early stages, stomach cancer is often asymptomatic or causes only mild epigastric discomfort, frequently mistaken for gastritis. Warning signs that warrant medical evaluation include unintentional weight loss, early satiety, persistent abdominal pain, nausea, anemia without an apparent cause, dark stools or vomiting blood, and progressive difficulty swallowing. The presence of these symptoms does not confirm the diagnosis but indicates the need for investigation by upper gastrointestinal endoscopy.
Which tests confirm the diagnosis of stomach cancer?+
The initial examination is upper gastrointestinal endoscopy with biopsy, which allows visualization of the lesion and determination of its histological type. For staging, computed tomography of the abdomen and chest is used, along with endoscopic ultrasound in selected cases and, when peritoneal dissemination is suspected, diagnostic laparoscopy. Blood tests, including tumor markers, complement the evaluation but do not replace biopsy for diagnostic confirmation.
How long does gastrectomy surgery take?+
Duration varies according to the extent of resection, the surgical approach, and the complexity of the lymphadenectomy, and may range from approximately three to six hours. Total gastrectomies and more complex reconstructions, such as esophagojejunostomy, tend to require more time than subtotal gastrectomies. The exact duration can only be estimated after individual case assessment and definition of the surgical plan.
What type of anesthesia is used for stomach surgery?+
Gastrectomy is performed under general anesthesia, frequently combined with regional or epidural analgesia techniques for postoperative pain control. The pre-anesthetic evaluation, conducted by the anesthesiology team, considers the patient's clinical condition, comorbidities, and complementary tests to define the safest approach for each case.
How many days of hospitalization are required after gastrectomy?+
Length of hospital stay varies according to the technique used, the surgical approach, and each patient's clinical progress, generally ranging from five to ten days. Laparoscopic or robotic surgery may favor faster recovery in some cases. Hospital discharge depends on resumption of oral feeding, pain control, and the absence of complications, and is determined individually.
What is postoperative pain like after gastrectomy?+
Pain is expected in the first days after surgery and is controlled with multimodal analgesia, including intravenous medications, regional blocks, and, when indicated, epidural analgesia. Intensity tends to decrease progressively throughout the hospital stay. Adequate pain control favors early mobilization, reducing the risk of respiratory and thromboembolic complications.
Are drains or a nasogastric tube necessary after surgery?+
The use of an abdominal drain and, in some cases, a nasogastric tube or a feeding tube for enteral nutrition (jejunostomy) is decided according to the surgical technique, the complexity of the reconstruction, and the postoperative recovery protocols adopted by the team. When used, these devices are generally removed progressively during the hospital stay, according to the patient's clinical progress.
Does the surgery leave large scars? Is a laparoscopic or robotic option available?+
It depends on the surgical approach. In open surgery, there is a larger midline abdominal incision. In laparoscopic and robotic techniques, small incisions are used, which may reduce the size of the scars and, in some cases, favor recovery. The indication for the most appropriate approach depends on tumor extent and the patient's individual characteristics.
How long am I off work after gastrectomy?+
Time off work typically ranges from four to eight weeks, depending on the surgical approach, the extent of surgery, occupational activity, and individual recovery response. Jobs requiring intense physical effort may require a longer leave. Return to activities is assessed on a case-by-case basis during postoperative follow-up.
What are the risks and complications of gastrectomy?+
As with any major abdominal oncologic surgery, risks include bleeding, infection, fistula at the suture line or anastomosis, respiratory complications, thromboembolism, and, in the medium and long term, nutritional changes such as dumping syndrome and vitamin B12 deficiency, especially after total gastrectomy. Frequency and severity vary according to the case and should be discussed individually.
Are there contraindications to surgery, and when is additional chemotherapy necessary?+
Surgery may not be indicated in disseminated metastatic disease or when the patient's clinical condition poses an elevated surgical risk, a situation assessed individually. In locally advanced tumors, perioperative chemotherapy, neoadjuvant and/or adjuvant, is added, defined jointly with the clinical oncologist. Treatment is conducted by a multidisciplinary team, including the surgeon, oncologist, nutritionist, and other specialists as needed.
Hospital facilities in Uberlândia, Brazil.
Hospital Mater Dei Santa Genoveva
Av. Vasconcelos Costa, 967 — Martins, Uberlândia-MG
Open in Google Maps →Content reviewed by Dr. Solon Gonçalves Souza Menezes — CRM-MG 79366, RQE 60355 (GI Surgery), RQE 44656 (General Surgery). Professor of Surgery at FAMED-UFU and Supervisor of the General Surgery Medical Residency Program at HC-UFU. ORCID. Last reviewed: September/2026.
- Barchi LC, Ramos MFKP, Dias AR, et al. Brazilian Gastric Cancer Association Guidelines (Part 2): update on treatment. Arq Bras Cir Dig. 2021;34(1):e1563. doi:10.1590/0102-672020210001e1563
- Barchi LC, Ramos MFKP, Yagi OK, et al. Brazilian Gastric Cancer Association Guidelines (Part 1): update on diagnosis, staging, endoscopic treatment and follow-up. Arq Bras Cir Dig. 2020;33(3):e1535. doi:10.1590/0102-672020200003e1535
- Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with FLOT vs FLC/ECF for gastric or GEJ adenocarcinoma (FLOT4). Lancet. 2019;393(10184):1948-1957. doi:10.1016/S0140-6736(18)32557-1
- Lu J, Xu BB, Zheng HL, et al. Robotic versus laparoscopic distal gastrectomy for resectable gastric cancer: a randomized phase 2 trial. Nat Commun. 2024;15(1):4668. doi:10.1038/s41467-024-49013-6