Upper GI cancer surgery · UK
Gastrectomy — a patient guide to stomach cancer surgery in the UK.
Partial or total removal of the stomach — for gastric adenocarcinoma, hereditary diffuse gastric cancer, GIST and a small number of other indications. Delivered through the NHS oesophago-gastric cancer network, or privately in a hospital equipped for major upper GI surgery.
Why patients choose us
- 01
A high-volume upper GI surgeon, in a specialist unit
Not a district general. A named consultant upper GI surgeon working inside a commissioned oesophago-gastric cancer centre — the setting NICE and the NHS OG network expect.
- 02
FLOT chemotherapy sequenced properly
Neoadjuvant FLOT before surgery, adjuvant FLOT after — sequenced with the MDT so nothing slips. The FLOT4 evidence is the current UK standard for locally advanced gastric adenocarcinoma.
- 03
Independent, and free
We are paid by no hospital, so the recommendation — including whether NHS or private is the right route for you — is impartial and costs you nothing.
Indicative pricing
What a gastrectomy costs — NHS and privately.
Free at point of care through the NHS. Indicative private ranges across our partner hospitals — we quote firm figures once we understand your case.
In short
NHS: free at point of care. Private: £30,000–£60,000 for surgery, plus chemotherapy.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| NHS pathway (specialist OG centre) | Free at point of care | Per NHS pathway | MDT-led |
| Private laparoscopic distal gastrectomy | £30,000–£45,000 | 4–6 hr | 7–10 day stay |
| Private open or robotic total gastrectomy | £40,000–£60,000 | 5–8 hr | 10–14 day stay |
| Perioperative FLOT chemotherapy (private) | £25,000–£45,000 | 8 cycles | ~6 months |
| Staging laparoscopy | £3,500–£6,000 | 45–60 min | Same day |
| Second-opinion consultation | £300–£600 | 45 min | Report within 48 hr |
Private prices vary by hospital, by surgeon, by the exact operation and reconstruction, by how long you stay on HDU or ITU, and by whether adjuvant chemotherapy is bundled or billed separately. We come back with a firm quote — and an honest view on whether private is the right route at all.
The problem
A specialist unit, a full MDT, and FLOT sequenced properly.
Gastrectomy for cancer is not the operation to have at a low-volume unit. Outcomes hinge on surgical volume, MDT breadth, and getting the chemotherapy sequence right around surgery.
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Newly diagnosed?
We help you get the staging complete, the MDT convened, and the treatment plan agreed — without weeks of chasing.
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Second opinion on the plan?
A named upper GI surgeon reads your scans and pathology and tells you honestly whether the operation and chemotherapy sequence proposed is the right one.
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NHS or private?
This operation is centralised on the NHS for good reasons. We will tell you honestly which route fits your case — impartial advice, no clinic on the hook.
The pathway
From diagnosis to recovery — what happens, in order.
The gastrectomy pathway spans several months. One clinician holds it together from diagnosis through adjuvant chemotherapy and into long-term follow-up.
Phase 1 · Before surgery
Staging, MDT, FLOT, prehab
Phase 2 · The operation
Theatre, HDU/ITU, ward
Phase 3 · After
Adjuvant FLOT, lifelong follow-up
- 01
Before
You send us the diagnosis
Endoscopy report, biopsy result, CT scan — however you have them. A short, confidential form. We read everything before we reply.
- 02
Before
MDT review and staging
Upper GI surgeon, medical oncologist, radiologist, pathologist, CNS and dietician review the case. Any missing staging — CT chest/abdo/pelvis, PET-CT for locally advanced, staging laparoscopy for peritoneal disease — is arranged.
- 03
Before
Neoadjuvant chemotherapy (FLOT)
For locally advanced gastric adenocarcinoma the current UK standard is perioperative FLOT — docetaxel, oxaliplatin, leucovorin and 5-FU — four cycles before surgery, four cycles after. Prehab, nutrition, anaemia, smoking and alcohol are addressed in parallel.
- 04
Before
Prehab and fitness assessment
CPET, dietician-led nutritional optimisation, exercise programme, iron infusion if anaemic. The evidence is clear that fitter patients recover faster after major upper GI surgery.
- 05
The operation
The operation
Distal (subtotal), total or — rarely — proximal gastrectomy with a D2 lymphadenectomy, the UK standard per NICE. Open upper midline or minimally invasive laparoscopic/robotic in high-volume centres per KLASS-02 and LOGICA. Reconstruction is Roux-en-Y esophagojejunostomy for total, Billroth I/II or Roux-en-Y gastrojejunostomy for distal. A feeding jejunostomy is standard for total.
- 06
The operation
HDU or ITU for 24–48 hours
Thoracic epidural, early oral fluids where possible, mobilise day one on the enhanced recovery pathway. Typical inpatient stay is seven to fourteen days.
- 07
After
Adjuvant chemotherapy and recovery
Adjuvant FLOT usually restarts six to twelve weeks after surgery. Full recovery from the operation itself is six to twelve weeks. Nutrition, B12, iron and dumping syndrome are managed lifelong by the dietician and CNS.
Typical end-to-end: 6 months from diagnosis through adjuvant FLOT. Recovery from surgery itself: 6–12 weeks.
When it helps
When a gastrectomy is the right operation.
The indications we see most, plus the red flag that means A&E rather than an outpatient appointment.
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Gastric adenocarcinoma
The commonest indication — cancer of the stomach lining. Curative surgery is the goal wherever the disease is resectable.
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Hereditary diffuse gastric cancer
CDH1 (or CTNNA1) mutation carriers are offered prophylactic total gastrectomy — the only reliable way to eliminate lifetime risk.
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Gastric GIST
Gastrointestinal stromal tumours of the stomach — often treated by wedge or partial gastrectomy, sometimes with imatinib around surgery.
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GOJ (Siewert III) tumours
Tumours at the gastro-oesophageal junction classified as Siewert III are managed as gastric cancers — usually total or extended total gastrectomy.
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Recurrence after partial resection
Where cancer recurs at the anastomosis or gastric stump, completion gastrectomy may be the right operation.
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Refractory or bleeding ulcer disease
Rare in the modern era — reserved for ulcers that will not heal despite maximal medical therapy, or catastrophic bleeding.
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Palliative gastrectomy
Occasionally offered for uncontrollable bleeding or obstruction from advanced disease — a symptom-control decision, not a curative one.
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Red flag: haematemesis or perforation
Vomiting blood, black tarry stools or sudden severe abdominal pain with a known gastric tumour is an emergency — 999, not an outpatient booking.
Procedure options
The different operations under the gastrectomy umbrella.
The right operation depends on tumour location and stage, on your fitness, and on the surgeon and hospital doing it. This is the shortlist.
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Distal (subtotal) gastrectomy
For antral and distal body tumours. Two-thirds to three-quarters of the stomach is removed. Reconstruction is Billroth I, Billroth II or Roux-en-Y gastrojejunostomy.
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Total gastrectomy
For proximal, body-encompassing or diffuse tumours, Siewert III GOJ tumours, and prophylactic surgery in CDH1 carriers. Reconstruction is Roux-en-Y esophagojejunostomy with a feeding jejunostomy.
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Proximal gastrectomy
Now rare — largely superseded by total gastrectomy because of severe reflux after proximal-only resections. Occasionally selected for very early proximal tumours.
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D2 lymphadenectomy
The UK standard per NICE NG83 — clearance of perigastric and named coeliac-axis nodes. Done at high-volume centres where mortality is lowest.
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Laparoscopic / robotic gastrectomy
Increasingly adopted in UK specialist centres per KLASS-02 and LOGICA — comparable oncological outcomes, less pain, faster recovery. Concentrated where volume and expertise justify it.
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Completion gastrectomy
Removal of the remaining stomach after a previous partial resection — usually for recurrence or metachronous cancer at the gastric stump.
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Staging laparoscopy
A short procedure done before definitive surgery to look for peritoneal disease that CT and PET miss. It can change the whole plan.
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Second-opinion review
A named upper GI surgeon reads your scans and pathology and tells you honestly whether the plan on the table is the right one. No obligation.
Our vetted UK network
A small panel of upper GI surgeons, at specialist OG centres.
Consultant upper GI cancer surgeons at commissioned NHS oesophago-gastric centres and their private counterparts. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every surgeon and unit in our network.
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Consultant upper GI surgeons at commissioned OG cancer centres, not district general units
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Full MDT including surgery, medical oncology, radiology, pathology, CNS and dietician
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FLOT perioperative chemotherapy delivered per FLOT4 protocol
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D2 lymphadenectomy as standard, with laparoscopic and robotic options where appropriate
Safety, complications and life afterwards
What to expect afterwards — honestly.
Gastrectomy is major surgery with a recognised complication profile and lifelong nutritional consequences. Being told this honestly, up front, is part of good care.
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Anastomotic leak: 5–10%
The most-feared early complication. Managed with drains, antibiotics, ITU support and — occasionally — return to theatre. Specialist centres detect and treat leaks earlier, which is why volume matters.
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Chest complications
Pneumonia, atelectasis and rarely ARDS. Prehab, thoracic epidural, early mobilisation and rigorous chest physiotherapy meaningfully reduce the risk.
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Atrial fibrillation: 15–25%
Common after major upper GI surgery, usually transient, managed by the cardiology and anaesthetic team on HDU or ITU.
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Splenic or pancreatic injury
Splenic injury during D2 dissection may require splenectomy — which means lifelong pneumococcal, meningococcal and Hib vaccination plus prophylactic penicillin. Pancreatic tail injury can cause a chyle or pancreatic leak.
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Dumping syndrome and reflux
Early and late dumping after distal gastrectomy; bile reflux esophagitis after total. Managed by portioned meals, avoiding simple sugars, lying flat after eating and dietician-led follow-up.
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B12, iron and vitamin deficiency
After total gastrectomy, intrinsic factor is lost — lifetime three-monthly intramuscular B12 injections. Iron, calcium, vitamin D and folate need lifelong monitoring and supplementation.
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Weight loss, then a new normal
Ten to fifteen percent weight loss in the first year is expected. Small frequent meals, protein-first eating and dietician support are non-negotiable — this is a lifelong pattern, not a phase.
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Long-term surveillance
Anaemia, nutritional bloods, and — for some patients — endoscopic surveillance of the anastomosis or gastric remnant. The surveillance schedule is debated; your MDT will tell you what fits your case.
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30-day mortality: 2–5% in specialist centres
Gastrectomy is major surgery. Thirty-day mortality is meaningfully lower at high-volume specialist units — which is why NHS oesophago-gastric cancer surgery has been centralised.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever operation was performed and whatever the reconstruction, the note the surgeon and pathologist send keeps to the same shape.
A quiet reminder
Surgical and pathology language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your MDT review, just ask.
- 01 Header
Indication, staging and extent of resection
Why the operation was done — the tumour type, cTNM stage from staging, and whether a distal, total or proximal gastrectomy was performed.
- 02 Technique
Approach, reconstruction and lymphadenectomy
Open, laparoscopic or robotic; D1 or D2 nodal clearance; the reconstruction — Billroth I/II, Roux-en-Y gastrojejunostomy or Roux-en-Y esophagojejunostomy — and whether a feeding jejunostomy was fashioned.
- 03 Findings
Pathology, margins and node count
The pathologist’s report: histological subtype (intestinal, diffuse, mixed), pTNM stage, R0/R1/R2 resection margins, and the number of lymph nodes examined and involved.
- 04 Impression
Adjuvant plan and lifelong follow-up
Read this first: whether adjuvant FLOT is recommended, when it restarts, and the lifelong nutritional and surveillance plan agreed with the MDT.
Recognised by major UK insurers
Cover for gastrectomy for cancer varies by insurer and by pathway. Most policies cover surgery, HDU/ITU and chemotherapy for a covered diagnosis — we confirm cover, excesses and any pre-authorisations before booking.
Frequently asked
Everything patients ask us about gastrectomy.
Quick answers on total versus distal, FLOT chemotherapy, recovery, risks and life afterwards.
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What is a gastrectomy, and when is it needed?
A gastrectomy is the surgical removal of part or all of the stomach. The commonest reason is gastric adenocarcinoma — cancer of the stomach lining. It is also done for CDH1-mutation carriers (prophylactic total gastrectomy for hereditary diffuse gastric cancer), for gastric GIST tumours, and occasionally for refractory ulcer disease. Bariatric sleeve gastrectomy is a different operation done for obesity — see our sleeve gastrectomy guide.
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What is the difference between a total and a distal gastrectomy?
A distal (subtotal) gastrectomy removes the lower two-thirds to three-quarters of the stomach and is used for tumours in the antrum or distal body. A total gastrectomy removes the whole stomach and is used for proximal, body-wide or diffuse tumours, Siewert III GOJ tumours, and for CDH1 carriers. The reconstruction is different and the long-term nutritional consequences of a total gastrectomy are more significant.
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What is FLOT chemotherapy?
FLOT is a four-drug combination — docetaxel, oxaliplatin, leucovorin and 5-fluorouracil — that is the current UK standard perioperative chemotherapy for locally advanced gastric adenocarcinoma, following the FLOT4 trial. Four cycles are given before surgery and four after, sequenced by the MDT.
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Should this be done on the NHS or privately?
Gastrectomy for cancer is highly centralised on the NHS — commissioned oesophago-gastric cancer centres deliver most cases, with the MDT expertise and volume that outcomes require. Going private for this operation is not automatically better; it can be right where you want a specific surgeon, faster access, or a second opinion, but only in a hospital equipped for major upper GI surgery. We will tell you honestly which route fits your case.
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How long is recovery from a gastrectomy?
Inpatient stay is typically seven to fourteen days, including 24–48 hours on HDU or ITU. Full recovery from the operation itself takes six to twelve weeks. Adjuvant FLOT chemotherapy — if planned — usually restarts six to twelve weeks after surgery, so the whole perioperative journey is several months.
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What are the main risks?
The most feared early complication is an anastomotic leak (5–10%), managed by drains, antibiotics, ITU support and occasionally reoperation. Chest complications, atrial fibrillation (15–25%), splenic or pancreatic injury, dumping syndrome and reflux are all recognised. Thirty-day mortality is 2–5% at specialist centres — meaningfully lower than at low-volume units, which is why NHS OG surgery has been centralised.
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What happens to eating and nutrition afterwards?
Meals become small and frequent, and stay that way for life. After a total gastrectomy you will need lifetime three-monthly intramuscular vitamin B12 injections (intrinsic factor is lost), plus lifelong iron, calcium, vitamin D and folate monitoring. Weight loss of ten to fifteen percent in the first year is expected. Dumping syndrome is managed by avoiding simple sugars, eating protein first and lying flat after meals. A specialist upper GI dietician is non-negotiable.
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What about laparoscopic or robotic gastrectomy?
Minimally invasive gastrectomy — laparoscopic or robotic — is increasingly adopted in UK specialist centres. The KLASS-02 and LOGICA trials show comparable oncological outcomes with less pain and faster recovery. Availability is concentrated at high-volume centres; the right approach for your case depends on tumour location, stage and surgical expertise.
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CT chest / abdomen / pelvis
The staging scan for oesophago-gastric cancer.
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All tests & procedures
Every test and procedure we arrange.
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