Stomach Cancer Surgery – Gastrectomy

Stomach Cancer Surgery

What should I do before a Gastrectomy or Stomach Cancer Operation?

Prior to an operation, patients should keep active with regular gentle exercises. This will aid in the process of recovery. Having a healthy and well-balanced nutrition will aid the healing process. Stopping smoking will greatly help reduce wound infections, lower the risk of blood clots and may even lower the risk of joint (anastomosis) problems.

What does the Stomach Cancer Surgery entail?

There are various ways to remove a gastric cancer and a few techniques involved in the reconstruction. Instead of describing each technique individually, it is important to understand the rationale of the operation. In general, these operations are done either as an open technique or keyhole (laparoscopic).

To achieve a “radical resection”, the surgeon needs to remove the cancer together with some normal tissue. This is known as clear margins of resection. This means that either all (total gastrectomy) or some (partial or distal gastrectomy) of the stomach is removed. The type of resection is dependent on where the cancer is located in the stomach. In selective cases, an adjacent organ may be removed if it was determined that the disease invades. Sometimes the gallbladder is removed even-though there is no active disease but it has gallstones.

As part of the radical resection, most lymph nodes draining the cancer are removed. Cancers spread commonly through the lymph nodes and less commonly via the blood stream. Particular attention is paid to the removal of these first station lymph nodes (D1) and the next station of lymph nodes (D2) that drain the first station (D1). This is commonly referred to as a “D2 gastrectomy”. It will tell us if the patient has responded to chemotherapy as well as the extent of the disease. It helps control the cancer locally and prolongs survival in the long term.

The re-construction process depends on whether there is any stomach left. If there is, a suitable section of small bowel is brought upwards and re-joined to the remnant stomach. If all the stomach is removed (total gastrectomy), then the small bowel is often fashioned into a pouch and re-joined to the oesophagus.

Sometimes a temporary route of feeding is established. This would usually be after a “total gastrectomy”. This temporary access is usually known as a “feeding jejunostomy”. A suitable tube in placed inside a small bowel for hydration and feeding. This would provide adequate nutrition, energy and fluid while healing takes place. This feeding tube will stay in for a couple of weeks even if not used. It is easily removed in the consultation rooms. These tubes can also be easily blocked and care of the tube must be taken meticulously. Sometimes drain tubes are used to draw unwanted fluids away. Sometimes a “tube down the nose” known as a nasogastric or nasojejunal tube is placed near the joint.

These operations are done either as a traditional open technique or minimally invasive (keyhole, robotic). All of this will take approximately 3 to 5 hours. One may expect to be in hospital for an average of 7 days.

Recovery from Stomach Cancer Surgery

After the operation, the patient plays a crucial role in assisting with recovery. It is an uncomfortable operation. With pain relief, the patient will still have some discomfort but should be able to take deep breaths and cough gently.

Despite some discomfort, patients must actively participate and take the initiative in regular chest exercises clearing all secretions. Otherwise, these lung secretions can accumulate and lead to lung infections. Walking around the ward and sitting out of bed is strongly encouraged. These simple steps help to re-expand the lungs. The ward physiotherapist will assist you along your recovery. The discomfort will improve with time and most patients would not need strong pain relief on discharge.

Stomach Cancer Recovery in the Long Term

A lifestyle change may be required as the volume of the “new stomach” is reduced. In the case of a “total gastrectomy”, regurgitation can be a problem. Before the operation, the body has inbuilt anti-reflux mechanisms. These have been disrupted with the operation especially when lymph nodes are cleared. Simple lifestyle adjustments are required.

These include sleeping on 1 or 2 pillows (known as head elevation) and not having a meal late at night. During the evening, it is best to have food or fluids that would not hang around for long. Often this means having your heaviest meals in the afternoon (when you are on your feet) and possibly having soups or drinks in the evening. Plan to stay upright for a couple of hours to allow “emptying” before going to bed.

Nutritional deficiencies can occur as well as weight loss. This will stabilise over time. It is important to monitor certain vitamins and minerals as well as having regular replacements. These currently include Iron, B12, Folate, Vitamin D and calcium. There may be additional test requested by your practitioner.

Some patients may encounter “dumping syndrome”. It is a condition that can be present in two phases, early and late. Essentially it involves movement of food into the small bowel quicker than desired, thus causing shifts in the bodily fluids.

Early symptoms can include bloating, cramping, diarrhoea, dizziness and fatigue. Late symptoms can include sweating, dizziness and lethargy. This occur a couple of hours after food (usually to 6 hrs). They appear to be related to the body’s response to the type of food exposed (typically sugars). Most of the time, these symptoms are an annoyance but seldom dangerous. There is an abundant literature on the website and many health practitioners would be able to advise you accordingly.

Most patients adjust well after these operations. Often patients do need emotional support and monitoring of their nutrition and weight. When all wounds have healed, continuing chemotherapy may be required.