Gastrectomy for Stomach Cancer: An In-depth Guide for Patients
Introduction and Terminology of the Procedure
A gastrectomy is a surgical procedure performed to remove part or all of the stomach, often used as a treatment option for stomach cancer. This procedure can be classified into three types: partial gastrectomy, total gastrectomy, and sleeve gastrectomy. In a partial gastrectomy, only a portion of the stomach is removed, whereas a total gastrectomy involves removing the entire stomach. In the case of a sleeve gastrectomy, a large part of the stomach is removed, leaving a thin gastric ‘sleeve’. Based on recent data, the utilization of gastrectomy for the treatment of stomach cancer in the USA is considerable, forming a key part of the broader strategy to address this serious health condition.
Indications for Gastrectomy
The primary indication for a gastrectomy is the presence of stomach cancer. This procedure might be recommended if:
- There is a gastric tumor that can be completely removed with surgery.
- There is a need to alleviate symptoms such as pain and bleeding in cases of advanced cancer.
- There are precancerous changes or early-stage cancer that affect the entire stomach.
- The patient has a genetic mutation that significantly increases the risk of stomach cancer (a prophylactic or preventive gastrectomy may be recommended).
The decision to undergo a gastrectomy should be taken after comprehensive discussion with your medical team about the nature of your cancer, the potential benefits of the procedure, its possible complications, and other treatment options.
Pre-Op Preparation
Preparing for a gastrectomy involves a number of important steps. You may be required to fast, adjust your medications, and complete pre-operative labs or imaging. It’s also necessary to secure pre-clearance authorization, consider your transportation options, and obtain any necessary work or school notes.
Remember, your doctor will provide specific instructions based on your individual circumstances. It’s essential to discuss with your doctor about any medications you’re taking and whether they should be stopped before the procedure, and when they can be resumed after the procedure.
Our telemedicine primary care practice is here to support you with all aspects of pre-operative clearances and ordering of pre-op labs and imaging. Please don’t hesitate to contact us for personalized assistance. Remember, every patient is unique, and your preparation may differ based on your specific health condition.
Note: This information is intended to provide general guidance and may not apply to all individuals. Always consult your healthcare provider for personalized medical advice.
Procedure Technique for Gastrectomy
Gastrectomy is a surgical procedure that involves the removal of part or all of the stomach. The exact method and process can vary depending on the specifics of your case, but the following is a general step-by-step guide to what you can expect during a typical gastrectomy.
Preoperative Preparation
Before the operation, you will be placed under general anesthesia, which means you will be asleep and won’t feel any pain during the surgery. Your surgeon will make sure all necessary tests are complete and review the procedure details with you and the surgical team.
Making the Incision
The surgeon will make an incision (cut) in your abdomen. The size and location of this cut will depend on whether the operation is open surgery or laparoscopic surgery. In open surgery, a single, larger incision is made, while in laparoscopic surgery, several smaller incisions are made to accommodate specialized surgical instruments and a camera for the surgeon to view the procedure.
Removing the Stomach
Next, the surgeon will remove the part or all of your stomach. In a partial gastrectomy, only a part of the stomach is removed, usually the portion containing the cancer. In a total gastrectomy, the entire stomach is removed.
Reconnecting the Digestive System
After the stomach, or the part of it, has been removed, the surgeon will then reconnect the remaining parts of your digestive system. If only part of your stomach was removed (partial gastrectomy), the remaining part of your stomach will be reconnected to your esophagus and small intestine. If your entire stomach was removed (total gastrectomy), the surgeon will connect your esophagus directly to your small intestine.
Closing the Incision
Once the reconnection is complete, the surgeon will close the incisions using stitches, staples, or surgical glue. A dressing will be applied to protect the wounds as they heal.
Recovery in the Post-Anesthesia Care Unit (PACU)
After the surgery is complete, you’ll be moved to a recovery room, also known as the post-anesthesia care unit. Here, medical staff will monitor your vital signs as you wake from the anesthesia. This is a standard part of the procedure to ensure your body is responding well after surgery.
This is a general outline of what to expect during a gastrectomy. However, keep in mind that each patient’s situation is unique, and your surgeon will tailor the procedure to your specific circumstances and needs. It’s important to ask your medical team any questions you may have about the procedure, so you are fully informed and prepared.
Note: This information is intended to provide general guidance and may not apply to all individuals. Always consult your healthcare provider for personalized medical advice.
Duration of Gastrectomy
The duration of a gastrectomy procedure varies but typically lasts between two to four hours. This depends on the type of gastrectomy being performed and individual patient factors.
Post-Op Recovery from Gastrectomy
Following a gastrectomy, patients usually stay in the hospital for five to seven days. During this time, your medical team will monitor your recovery and manage any symptoms or side effects. Following discharge, you will likely need several weeks off work—anywhere from two to six weeks, depending on the nature of your job and how quickly your body recovers.
Follow-up appointments with your surgeon are generally scheduled for two weeks post-discharge, then at regular intervals for several months. These visits allow your doctor to monitor your healing, address any complications, and evaluate your progress in adapting to life after surgery.
While rehab or physical therapy is not typically needed, some patients may benefit from nutritional therapy to help adjust to changes in digestion and food intake. Lifestyle changes, like a modified diet and smaller, more frequent meals, are usually required.
It’s important to note that recovery is a gradual process. Full recovery and adjustment to the new dietary changes may take a few months. Our primary care practice can provide support throughout your recovery process, offering extended hours to accommodate work or school schedules and provide necessary documentation.
Effectiveness of Gastrectomy
Gastrectomy can be an effective treatment for stomach cancer, especially when the cancer is detected at an early stage. The five-year survival rate for early-stage stomach cancer is around 68%, but this rate decreases significantly as the cancer progresses.
Certain factors can improve the effectiveness of a gastrectomy. These include early detection and intervention, the overall health of the patient, the type of stomach cancer, and the extent of cancer spread. Tumor size, location, and whether or not the cancer cells have spread to the lymph nodes or other parts of the body can all impact the procedure’s effectiveness.
Conversely, circumstances that can lower the effectiveness include advanced-stage cancer, poor overall health status, and the presence of other serious medical conditions. Also, cancer recurrence post-surgery can affect long-term outcomes.
The decision to proceed with a gastrectomy should be based on a thorough discussion with your healthcare provider about the potential benefits, risks, and alternatives, taking into account your personal preferences, values, and circumstances.
Note: This information is intended to provide a general understanding of the gastrectomy procedure and may not cover all situations. Always consult your healthcare provider for personalized medical advice.
Adverse Events with Gastrectomy
Like any major surgical procedure, gastrectomy comes with certain risks and potential complications. Some of these adverse events include:
- Bleeding (3-8%): This is an excessive loss of blood that can occur during or after surgery. Bleeding can lead to a drop in blood pressure and may require a blood transfusion.
- Infection (15-20%): Infections can occur at the surgical site or internally, potentially leading to complications such as abscesses, blood poisoning (sepsis), or organ failure.
- Leakage from the stomach (1-5%): This is a serious complication where the newly formed connections between the remaining stomach and the intestines leak, potentially causing an infection or abscess.
- Nutritional deficiencies (varies): As the stomach’s size is reduced, you may not be able to consume or absorb enough nutrients, leading to deficiencies. Dietary modifications and supplements can help manage this.
The overall mortality rate from a gastrectomy procedure is approximately 1-3%, depending on patient factors and the stage of cancer. Your healthcare provider will discuss these risks with you in detail and provide strategies to manage and minimize them.
Alternatives to Gastrectomy
If a gastrectomy is not a suitable option for you, or if you’re exploring alternatives, other treatments for stomach cancer include:
- Chemotherapy: This is the use of drugs to destroy cancer cells, usually by stopping the cells’ ability to grow and divide.
- Radiation therapy: This treatment uses high-energy rays (similar to X-rays) to kill or shrink cancer cells.
- Immunotherapy: This treatment boosts the body’s natural defenses to fight cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function.
- Targeted therapies: These are drugs that specifically target the changes in cells that cause cancer.
Lifestyle modifications, such as maintaining a healthy weight, eating a balanced diet, and regular exercise, can support overall health and well-being during and after treatment.
Experimental or Emerging Technologies
Medical research is continually exploring new ways to treat stomach cancer. One emerging approach is the use of robotic surgery. This method employs robotic systems to perform surgery, potentially offering more precision, flexibility, and control than is possible with conventional techniques. However, more research is needed to understand its long-term benefits and risks in treating stomach cancer.
Conclusion
Undergoing a gastrectomy is a significant decision, requiring a thorough understanding of the procedure, recovery, effectiveness, and potential complications. There are alternative treatments available, and new technologies are continually emerging. This knowledge can empower you in your discussions with your healthcare provider, enabling you to make the best decisions for your health and wellbeing.
Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.