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For a small, early cancer at the top of the stomach, the whole stomach does not always have to come out. The lower stomach can be kept and joined so that food has two paths onward. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 5 October 2026
Shah’s Gastro, Cancer & Robotic Surgery Centre. Super-specialty training in surgical gastroenterology, two higher degrees in it, and 18 years of experience in GI and cancer surgery. Whether part of the stomach can be kept is decided only after the tumour board has reviewed the endoscopy, the biopsy type and the scans.
Most cancers at the top of the stomach need the whole stomach removed. A smaller group — early cancers confined to the inner layers, with no enlarged nodes on the scans, of a type that does not spread inside the wall — can be treated by removing only the upper stomach and keeping the lower part, the antrum.
After a proximal gastrectomy the food pipe is joined to a loop of small bowel, and the kept lower stomach is joined to the same loop further down. Food then has two paths — through the kept stomach and straight along the bowel — which is why it is called a double-tract reconstruction.
The robot does not change that operation. It helps with its three hardest parts: working high at the diaphragm, clearing the nodes near the spleen while keeping the spleen, and making and testing three joins inside the abdomen.
Keeping the lower stomach is possible only when every one of these holds: the cancer is early, it sits in the upper third of the stomach, there is no sign of node spread, it is a single tumour, its type under the microscope is not the diffuse kind that creeps inside the wall, and enough healthy lower stomach can be left above the outlet.
If the tumour is deeper, if nodes look involved, if chemotherapy is needed first, if it reaches well into the food pipe, or if the biopsy shows the diffuse or signet-ring type, the whole stomach is removed instead. That is the more common situation, and it is the standard operation for most upper-stomach cancers.
The decision is made at the tumour board from the endoscopy, the depth assessment and the scans. How those tests are done is covered on the robotic stomach cancer surgery page; this page is about the operation once the board has said the lower stomach can be kept.
The lower stomach still does useful work: it holds food for a while, grinds it, and releases it slowly. Keeping it, with a working connection to the food pipe, protects weight, blood counts and vitamin absorption in the years after surgery.
In the trial that compared this operation with total gastrectomy for early upper-stomach cancer, patients who kept the lower stomach held their weight and haemoglobin better, and vitamin B12 deficiency was far less common, while cancer control was the same. That is why the operation is offered to those who qualify.
The older way of keeping the lower stomach — joining it directly to the food pipe — caused troublesome acid and bile reflux, and is no longer preferred. The double-tract design avoids that by placing a loop of small bowel between the food pipe and the kept stomach. The trade-off is one more join than a total gastrectomy, and a somewhat higher chance of narrowing where the food pipe is joined, which is usually treated by stretching it at endoscopy. Some patients, told both sides, prefer the simpler total gastrectomy, and that choice is respected.
A proximal gastrectomy works where keyhole instruments are least comfortable: up under the diaphragm around the food pipe, and far to the left along the splenic artery. A wristed robotic instrument can turn to meet those tissues squarely instead of reaching them at a steep angle.
Around the pancreas, the robot’s advantage lies in how the nodes are removed. With fine bipolar energy in both of the surgeon’s instruments and the third arm holding the stomach, the node tissue is lifted off the pancreas rather than pressed against it. Less pressure on the pancreas means less risk of a pancreatic fluid leak after surgery, the complication that most often follows this part of the operation.
At the end, the robot’s suturing helps with three joins made inside the abdomen, and its built-in fluorescence camera shows the blood flow to each one. Nothing about the cancer operation is reduced: the same upper stomach, the same node field and the same margins are taken as in open surgery.
The patient lies on the back with the head raised. Four robotic ports form an arc across the upper abdomen, placed high enough to reach the diaphragm, with an assistant port for staplers and a small retractor under the breastbone to lift the liver off the stomach.
Because an early cancer often cannot be seen or felt from outside the stomach, a small clip or ink mark is placed at endoscopy before surgery to show where the stomach will be divided. The robotic camera finds that mark, so the cut is made at exactly the planned level and the lower stomach is kept as intended.
Positioning, padding and warming are finished before docking. If at any point the abdomen must be opened — a tumour more advanced than expected, or bleeding better controlled by hand — the arms are undocked and the operation continues open, as consented beforehand.
The operation follows five steps, each with its own care point. The order is fixed, so nothing is missed and the specimen comes out in one piece with its nodes labelled for the pathologist.
First, the left side: the omentum is freed along the greater curve, the short vessels between the stomach and the spleen are divided, and the nodes near the spleen are cleared with the spleen left in place. Second, the lesser curve: the main artery and vein of the upper stomach are divided at their origin and the nodes along the arteries above the pancreas are cleared. The CT is reviewed beforehand for a liver artery that sometimes arises from the stomach’s artery, because in this operation it must be kept.
Third, the hiatus: the food pipe is freed a short way up into the chest so the join can be made without tension. Fourth, the division: the food pipe is cut above the tumour and the margin is checked by frozen section while the patient is still asleep; the stomach is divided at the marked level, keeping the antrum. Fifth, the reconstruction, described below.
If the frozen section shows cancer at a margin, more is removed at once. If the findings at operation show that the lower stomach cannot safely be kept, the whole stomach is removed in the same operation — a possibility explained and consented for beforehand.
A loop of small bowel is brought up and joined to the end of the food pipe. Further down the same loop, the kept lower stomach is joined to it, and lower still the loop is joined back to the rest of the bowel so that bile and pancreatic juice enter well away from the food pipe.
The spacing between the joins matters: the stomach join is placed far enough below the food-pipe join that food can travel both through the kept stomach and straight along the bowel. The kept stomach survives on the blood vessels along its right side, which are deliberately preserved, and the fluorescence view is used at each of the three joins to confirm healthy blood flow before the abdomen is closed.
Every join is tested for air leaks under saline. A drain is placed selectively near the food-pipe join to reveal a leak early if one occurs. The warning signs afterwards are fixed: a pulse that stays fast, new or worsening abdominal pain, fever, or a change in the drain. Any of these means nothing by mouth, a CT scan and the consultant informed at once — never a wait until morning.
All three approaches remove the same upper stomach and nodes and make the same double-tract reconstruction. The differences lie in how each handles the hiatus, the spleen side and the three joins, in recovery, and in cost.
| Open | Keyhole (laparoscopic) | Robotic | |
|---|---|---|---|
| Incision | Long upper-abdominal cut | Small ports and one short cut | Small ports and one short cut |
| Working at the hiatus, under the diaphragm | Deep and awkward through the wound | Straight instruments at a steep angle | Wristed instruments reach up and around the food pipe |
| Nodes near the spleen, spleen kept | Direct, by hand | Demanding; frequent pressure on the pancreas | Third arm holds the stomach; nodes lifted off the pancreas with fine bipolar energy |
| Three joins inside the abdomen | Hand-sewn or stapled through the wound | Stapled; suturing high up is demanding | Stapled, with accurate suturing at each join |
| Checking blood flow to each join | Separate equipment | Separate fluorescence camera | Fluorescence view built into the robotic camera |
| Blood loss | Highest | Low | Low |
| Lymph node clearance | D2 standard | D2 standard | D2 standard |
| Hospital stay and return to activity | Longest, limited by the wound | Shorter | Similar to keyhole |
| Time in theatre | Shortest | Longer | Longest |
| Cost | Lowest | Moderate | Highest |
| Suited to | A bulky tumour, or one stuck to a neighbouring organ | Early upper-stomach cancer in a straightforward abdomen | Early upper-stomach cancer where the hiatus, the spleen side and three joins make precision count |
Keyhole surgery is a well-established way to do this operation, and robotic surgery adds precision where the dissection is deepest and the suturing highest. Dr Harsh Shah explains which approach suits your abdomen when he recommends it.
The whole stomach is removed when the tumour is deeper than early, when nodes are involved, when chemotherapy is needed before surgery, when the type is diffuse or signet-ring, when there is more than one tumour, when the cancer extends well into the food pipe, or when the lower stomach is itself affected.
Open surgery is preferred for a bulky tumour, one stuck to the pancreas, spleen or colon, or one that has grown through the stomach wall — judgement in the patient’s interest, not a lesser operation. A long operation with gas in the abdomen is weighed with the anaesthetist for patients with severe heart or lung disease. These decisions are made at the tumour board before the day, and the consent covers the possibility of changing course during the operation.
Eating returns step by step: sips on the first day, then liquids and soft food, and small, frequent meals for the first months while the joins settle. Because part of the stomach is kept, most people can return to fairly normal portions over time, eaten slowly.
An acid-reducing medicine is usually given for some weeks to protect the stomach join. Light-headedness or sweating soon after a sugary meal — dumping — can occur and improves with smaller portions. If food begins to stick when swallowing, the food-pipe join may have narrowed; it is checked by endoscopy and usually eased by stretching. Years later, colicky pain with vomiting needs urgent review for an internal hernia.
Because enough of the stomach is kept to absorb vitamin B12 in most people, routine lifelong injections are not needed as they are after a total gastrectomy. Instead, blood counts, iron and B12 are checked every year, and replaced if they fall. A dietitian is part of the pathway from the two-week visit.
★★★★★
“We are very thankful to Dr. Harsh Shah for treating and operating on my father for gastric (stomach) cancer. From the first consultation to the surgery and follow-up, he guided us with great care and explained everything clearly. My father is doing well now, and we are extremely grateful for the treatment and support provided by Dr. Harsh Shah and his team. He is a highly experienced and compassionate doctor. We would definitely recommend Dr. Harsh Shah to anyone looking for an experienced doctor for stomach cancer treatment. Thank you, Doctor, for everything! — Moh. Ahsan, Google review, Apollo Hospital, Bhat listing”
★★★★★
“Excellent doctor for stomach cancer. We r very happy. Recommend for gastro cancer treatment in Ahmedabad”
★★★★★
“We are much satisfied with robotic surgery done by Dr harsh shah. He is very humble in nature. Highly recommended for gastro cancer surgeon in Ahmedabad. Thank u so much sir. — Jyotsnaben Kotwal, Google review, Gota clinic listing”
Unedited Google reviews from patients treated for stomach cancer, quoted exactly as written, and patients speaking about their experience after stomach cancer surgery.
Maganbhai Parmar · Google review
Purshottam Meena · Google review
A robotic proximal gastrectomy costs more than an open or keyhole one, because of the robotic instruments used in each case and the longer theatre time; the fluorescence dye and any longer stay add to it. The office prepares a written estimate before admission.
Cashless admission is arranged at Apollo Hospital, Bhat where your policy allows it, and the pre-authorisation paperwork is prepared by the office. Ask whether your policy covers robotic surgery and up to what limit. Bring the policy documents, photo identity, the endoscopy and biopsy reports with slides, the CT on disc, and a list of current medicines.
Only if the cancer is early, single, in the upper third, of a type that does not spread inside the wall, with no node spread on the scans and enough healthy lower stomach to keep. The tumour board decides this from your endoscopy, biopsy and CT.
For early upper-stomach cancer that qualifies, cancer control is the same with either operation, and keeping the lower stomach protects weight, blood counts and B12. For cancers that do not qualify, the whole stomach is removed.
After the upper stomach is removed, food can travel two ways: through the kept lower stomach, and straight along a loop of small bowel joined to the food pipe. The design also stops acid and bile from washing back up.
Usually not, because the kept stomach lets most people absorb B12. Blood counts, iron and B12 are checked every year, and replaced only if they fall.
The join to the food pipe can narrow as it heals. It is checked by endoscopy and usually eased by stretching it. Tell the team rather than cutting down on food.
No, not routinely. The nodes near the spleen are cleared with the spleen left in place. It is removed only if the tumour has grown into it, and that is discussed before consent.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultation, review of MRI, CT and pathology reports, second opinions, follow-up and surveillance.
Google: 4.9 · 52 reviews
Apollo Hospital — Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Google: 5.0 · 25 reviews
Patients travel for stomach cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
More on robotic surgery for stomach cancer at this centre: Robotic stomach cancer surgery in Ahmedabad · Robotic cancer surgery at this centre · Robotic surgery for food pipe cancer · Stomach cancer explained
Send the endoscopy, biopsy and CT reports ahead of your appointment so the consultation starts with them already read. Whether the lower stomach can be kept, and by which approach, is decided at the consultation after examination and at the tumour board. Call +91-63590-11009 WhatsApp the office
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