A few years ago, a man in his early 60s visited my outpatient clinic after being diagnosed with early-stage stomach cancer. When stomach cancer is detected early, nine out of 10 patients survive for more than five years after surgery. Based on the endoscopy and biopsy results, his was a typical case of early-stage stomach cancer, with a very high chance of complete cure if he received proper surgery. However, the patient gave up treatment, saying "surgery is too frightening," and left the hospital to try his own methods of healing. A few years later, when he was rushed to the emergency room with sudden hematemesis and severe anemia, the cancer had progressed beyond the stage where it could be resolved through surgery. Even in that state, the patient strongly refused treatment, and only after repeatedly persuading him along with his family that "starting treatment now can extend your survival and quality of life" did he finally begin chemotherapy. Fortunately, the bleeding was controlled with medication, but the outcome of the chemotherapy remains uncertain.
Korea's five-year survival rate for stomach cancer stands at about 78 percent, a significant improvement from around 40 percent in the 1990s. Thanks to the national cancer screening program and endoscopy, about 70 percent of stomach cancers are detected at the localized (early or confined) stage, where the five-year survival rate exceeds 95 percent. Some reports indicate that simply performing endoscopy during health checkups improves survival rates by more than 40 percent. This is because early diagnosis enables patients to receive optimal treatment before the cancer progresses. In fact, the five-year survival rate for Stage 1 stomach cancer patients who undergo surgery or endoscopic resection far exceeds 90 percent, and for Stage 1A, reports show rates above 94 percent, reflecting excellent treatment outcomes.
Stomach cancer surgery imposes a significant burden on patients, as it requires the removal of part or all of the stomach along with lymph nodes. However, Korea's overall outcomes for stomach cancer surgery are excellent, with surgical mortality and serious complication rates steadily declining. Research has shown that even when complications such as pneumonia, leakage, or bleeding occur within 30 days after surgery, there is no clear difference in long-term quality of life. While it is best to avoid complications, even when they occur, most patients recover through intensive care and rehabilitation and return to daily life. Recently, the expansion of function-preserving gastrectomy, laparoscopic surgery, and robotic surgery has produced good results in efforts to reduce complications and aftereffects while maintaining cure rates, thereby improving quality of life.
Several cohort studies report that while the quality of life of gastrectomy patients temporarily declines immediately after surgery, most recover to near pre-surgery levels within six months to a year. In particular, patients who undergo function-preserving surgeries such as partial gastrectomy or proximal gastrectomy tend to recover their nutritional status and daily activities more quickly. Long-term follow-up studies show that even after gastric resection, overall quality-of-life scores rise to levels similar to those of the general population, and even when some digestive symptoms remain, "the relief that the cancer is gone" and "freedom from pain and bleeding" outweigh the inconvenience. In other words, the vague fear that "having stomach cancer surgery means you can't eat or live normally for the rest of your life" is far from the actual data. It is not a question of "how can I live without a stomach?" but rather an era in which one can live well even without a stomach.
The most regrettable moments in the clinic come when patients lament, "If only I had had the surgery then." It is impossible to hide the sadness of meeting patients and family members who have reached an untreatable stage for various reasons — because they were afraid of treatment itself, lacked information, were misled by incorrect stories and left the disease unattended, were too busy, or failed to get screened. The purpose of stomach cancer treatment is not simply to remove the cancer but to protect both survival and quality of life so that patients can continue their daily lives five or 10 years later. Korea's stomach cancer treatment outcomes and the prognosis of early-stage stomach cancer surgery are already among the world's best. Patient satisfaction after surgery is also higher than many expect.
Some readers of this article may have postponed endoscopic screening because they were too busy, or considered giving up treatment out of fear of surgery or chemotherapy. If so, please do not decide alone — summon your courage, make the time, and visit a nearby hospital. The saying "courage is not the absence of fear, but acting in spite of fear" applies to health as well.
