Skip to main contentLast updated: 19-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Stomach Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.89 from 216 reviews (Gota clinic) · 4.94 from 18 reviews (Apollo, Bhat)
In short
Locally advanced stomach cancer has grown into or through the stomach wall, or reached nearby lymph nodes, with no spread to distant organs.
Chemotherapy is given before the operation and again after it. Most patients who are fit receive four cycles on each side.
The operation removes the lymph nodes along the stomach’s own blood vessels in a set pattern. That clearance is called D2.
A scan after chemotherapy decides whether the operation goes ahead. A tumour that did not shrink is usually still removed.
Three lines of the report settle this. How deep the tumour has grown, whether the nodes nearby hold cancer, and whether anything is seen further away.
Locally advanced means the first two are present and the third is not. The letters read as cT2 to cT4, N0 to N3, and M0.
| On the report | What it means |
|---|---|
| cT2 or cT3 | The tumour has grown into, or just through, the muscle layer of the stomach wall. |
| cT4a | The tumour has grown through the outer covering of the stomach. |
| cT4b | The tumour has grown into a neighbour, such as the pancreas, spleen or colon. |
| N1 to N3 | One or more lymph nodes near the stomach hold cancer. |
| M0 | No spread was seen in the liver, the lungs or the lining of the abdomen. |
A cT4b tumour is still locally advanced. It is the hardest group to plan, because removing it means taking part of the neighbouring organ with the stomach.
For this group, chemotherapy first is the standard. There are four plain reasons.
The same chemotherapy is then given again after the operation. This is why it is called peri-operative treatment, which simply means around the operation.
The half given after surgery is the part most often dropped. Appetite and strength return slowly, yet starting it when the body allows still matters.
Nutrition runs through all of it. Weight loss during the waiting weeks is the commonest reason a planned operation slips.
The operation takes the part of the stomach that holds the tumour, a rim of normal stomach around it, and the nodes that drain it. The tumour’s position decides how much stomach goes.
| Where the tumour is | Usual operation |
|---|---|
| Lower third | The lower part of the stomach is removed, and the remainder is joined to the small bowel. |
| Middle (body) | Part or all of the stomach. The distance from the tumour to the food pipe decides it. |
| Upper third | The whole stomach, with the lowest part of the food pipe if the tumour reaches it. |
| Spreading through the wall | The whole stomach, with wider rims of normal tissue above and below. |
The rim needed is not the same for every tumour. A cancer made of well formed glands needs a smaller rim than one made of scattered single cells. The edges are checked under the microscope while the operation is still going on.
Each of these operations is described in more depth on the pages for cancer in the lower stomach, cancer in the middle of the stomach and cancer at the top of the stomach.
The node clearance follows a set pattern along the arteries that feed the stomach. The spleen and the pancreas are not removed as a routine part of it. Nodes near the top of the spleen are taken while the spleen itself stays.
One line of the pathology report is a check on the operation. It says how many lymph nodes the laboratory found. At least sixteen should be examined, and specialist teams aim well above that.
Not every tumour shrinks. The scan done after chemotherapy sorts patients into three situations.
After the operation, the report on the removed stomach decides the rest. If the stage is higher than expected, chemotherapy continues. If an edge came back involved, a second removal is considered where it is possible, and radiotherapy with chemotherapy where it is not. If the first combination proved too hard to tolerate, a gentler pair of medicines is used for the second half.
A few locally advanced cancers are better not operated on, at least not first.
Here, treatment is led by medicine, and the aim is set out plainly before it starts. Which stomach cancers are operated on, and in what order, is covered on the page about the order of stomach cancer treatment.
Keyhole removal of the lower stomach with a D2 clearance is an accepted standard for this group, and large trials have shown it holds its own against the open operation. Keyhole removal of the whole stomach is done in specialist units. Robotic surgery is used in selected patients.
The route matters less than the clearance. A D2 node clearance with clear edges is the goal, whichever way the surgeon reaches it.
The open operation keeps a clear place. It is the right choice when a neighbouring organ has to come out with the stomach, and when a node clearance to this standard cannot be delivered any other way.
Radiotherapy is not usually added after a proper D2 clearance with chemotherapy on both sides of the operation. It is kept for two narrow situations: an operation in which the node clearance was limited, and an edge that came back involved and cannot be removed again.
Some patients reach theatre first. The cancer announced itself as an emergency, or the plan changed along the way. After a D2 operation, chemotherapy for about six months is then given instead. This is a sound plan, widely used, and it is what is offered here when the first half was missed.
| Question | Why it matters |
|---|---|
| Has a keyhole look with a saline wash been done? | It finds disease that changes the whole plan before a major operation. |
| How many cycles before surgery, and how many after? | It sets expectations for the second half, which is easy to abandon. |
| When will the response be checked, and with what test? | The date of that scan is the date the operation is confirmed. |
| Will the clearance be a D2, and who reports the node count? | Both are measures of whether the operation did its job. |
Giving it first shrinks the tumour, treats cells that may have travelled, and shows how the tumour responds. That response then guides the treatment after surgery.
Usually not. If the disease is still limited to the stomach and the nodes nearby, the operation goes ahead. It is called off only if new spread has appeared.
It means the lymph nodes along the stomach's own arteries are removed in a set pattern, not just the ones beside the tumour. The spleen and pancreas stay.
It is part of the same plan, and it is the half most often dropped. It is started when appetite and strength allow, and the dose is adjusted to what you can manage.
Removal of the lower stomach with a D2 clearance is a keyhole standard. Removal of the whole stomach is done this way in specialist units. A tumour growing into a neighbouring organ needs an open operation.
The full range of stomach cancer care is on the stomach cancer treatment page. For questions before you travel, call +91-63555-64601.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of endoscopy, biopsy and scan reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, GIDC Bhat Industrial Estate, Bhat, Gandhinagar. Staging laparoscopy, gastrectomy with D2 clearance and inpatient care.
Has the report called your stomach cancer locally advanced, and are you being offered chemotherapy before the operation? The endoscopy, biopsy, CT and laparoscopy reports can be sent ahead on WhatsApp, so the consultation starts with them already read. Your treatment is decided at the consultation, after examination. Call +91-63555-64601 Send reports before your visit
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