Stomach (Gastric) Cancer
Robotic gastrectomy with D2 lymph node dissection, planned as part of a coordinated treatment
Stomach cancer is treated best when surgery is one part of a coordinated plan rather than the first and only step. Dr. Papenfuss is a high-volume gastric surgeon at St. Luke's in Milwaukee who performs most gastrectomies robotically, serving patients from across Wisconsin.
What it is
Most stomach cancers are adenocarcinomas arising from the stomach lining. Risk factors include H. pylori infection, smoking, a family history, and certain inherited syndromes. Tumors at the junction of the esophagus and stomach (the GE junction) behave somewhat differently and are often treated with elements of both esophageal and gastric surgery. Early tumors may cause no symptoms; later ones cause pain, early fullness, weight loss or bleeding.
How it is treated
For all but the earliest tumors, chemotherapy is given before surgery and after to treat microscopic spread, and immunotherapy is now added to that chemotherapy for some patients. Surgery removes part or all of the stomach along with the surrounding lymph nodes:
Distal or subtotal gastrectomy for tumors in the lower stomach, keeping the upper stomach.
Total gastrectomy for tumors in the upper stomach or GE junction, with the esophagus joined directly to the small intestine.
Lymph node dissection (D2), removing the nodes along the major arteries, which is a standard that not every center follows and which affects staging and outcomes.
Diagnostic laparoscopy, a short camera procedure before major surgery to check for spread the scans cannot see.
Very early tumors confined to the lining may be removed endoscopically by gastroenterology without surgery.
Dr. Papenfuss's approach
Dr. Papenfuss performs robotic total and partial gastrectomy with D2 lymphadenectomy, which allows a precise node dissection through small incisions and typically a shorter recovery before chemotherapy resumes. Every patient is staged and planned with a multidisciplinary team of medical and radiation oncologists, gastroenterologists, radiologists and pathologists. Nutrition support is built into the plan from the first visit, since eating well through chemotherapy and after gastrectomy is part of recovering.
When to get a second opinion
If you were offered surgery without chemotherapy first, if a D2 dissection has not been discussed, or if you were told the cancer has spread and surgery is off the table, a second look is reasonable. Call 414-649-3240 or request a consultation.
This page is general information, not medical advice for any individual patient.