İstanbul Üniversitesi İstanbul Tıp Fakültesi Genel Cerrahi Anabilim Dalı
İstanbul Üniversitesi İstanbul Tıp Fakültesi Genel Cerrahi Anabilim Dalı
Stomach cancer achieves high success rates with surgery in the early stages. Prof. Dr. Hakan Yanar is an experienced surgeon specializing in laparoscopic gastrectomy and HIPEC.
Stomach cancer (gastric cancer) is a malignant tumor resulting from the uncontrolled proliferation of cells lining the inner surface of the stomach. It is the 5th most common type of cancer in the world. Adenocarcinoma, which accounts for 90-95% of cases, is the most common histological type.
Helicobacter pylori infection, consumption of salty and smoked foods, smoking, and genetic predisposition are among the important risk factors. Because it is often detected at an advanced stage at the time of diagnosis, it can follow an aggressive course; this once again highlights the importance of early diagnosis.
📌 Important: H. pylori eradication reduces the risk of stomach cancer by 35-40%. Do not delay getting a gastroscopy for dyspepsia complaints.
In case of unintentional weight loss, difficulty swallowing, persistent vomiting, black stools, or bloody vomiting (hematemesis), get a gastroscopy without delay.
Stomach cancer is often silent in its early stages or presents with nonspecific complaints:
Gastroscopy and biopsy are the gold standard for diagnosis. Staging is completed with CT, PET-CT, and EUS. Diagnostic laparoscopy is performed if peritoneal spread is suspected. HER2, MSI/MMR, and PD-L1 status directly affect the choice of treatment.
The treatment of stomach cancer is determined by the decision of a multidisciplinary oncology board. Surgery is still the cornerstone of curative treatment; however, it is combined with perioperative chemotherapy and targeted therapies.
Depending on the location of the tumor, partial (distal) gastrectomy or total gastrectomy is performed. In the laparoscopic method, intestinal continuity is restored (anastomosis) through small incisions. Prof. Dr. Hakan Yanar applies D2 lymph node dissection as a standard — this is a mandatory surgical step recommended by international guidelines to ensure adequate staging and cure.
Compared to open surgery, postoperative pain is significantly less; bowel functions recover earlier, and patients mobilize faster. Oncological outcomes are equivalent to open surgery.
In esophagogastric junction and upper abdominal surgery, it offers superior maneuverability in narrow spaces thanks to 3D HD imaging and 360° joint movement. In total gastrectomy, intracorporeal anastomosis is performed more safely; postoperative complications are reduced.
→ Detailed information about Laparoscopic & Robotic SurgeryIt is a heated chemotherapy method applied simultaneously with cytoreductive surgery in selected cases where stomach cancer has spread to the peritoneum. PCI score and patient performance determine the indication. Prof. Dr. Hakan Yanar is one of the few expert surgeons in Istanbul with a HIPEC certificate.
→ Detailed information about HIPECThe FLOT protocol (docetaxel, oxaliplatin, 5-FU, leucovorin) is applied before and after surgery; it increases the probability of R0 (clean margin) resection by shrinking the tumor and destroying micrometastases. In stage II-III stomach cancer, perioperative FLOT is the first-line recommendation of current international guidelines.
Trastuzumab is added in HER2-positive metastatic stomach cancer. In cases with PD-L1 CPS ≥5, nivolumab or pembrolizumab immunotherapy can be combined with systemic chemotherapy.
Nutritional adaptation after gastrectomy is critically important. It starts with a liquid diet in the first few days; gradually transitioning to soft and solid foods. To prevent dumping syndrome, small and frequent meals (6-8 times a day), low fluid intake during meals, and avoiding refined sugars are the basic rules.
After total gastrectomy, vitamin B12 must be supplemented with lifelong injections. Iron and calcium support are also necessary in most patients. Regular follow-up with a dietitian is mandatory.
Prof. Dr. Hakan Yanar is an experienced surgeon in the field of stomach cancer surgery at Istanbul University Istanbul Faculty of Medicine and Liv Hospital Ulus. He works in coordination with the multidisciplinary oncology board, and services are provided to international patients in Turkish, English, French, and Russian.
Contact Prof. Dr. Hakan Yanar today for early diagnosis and treatment.
