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Surgical Procedures for Stomach Cancer

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Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues. The main type of surgery used to treat stomach cancer is a gastrectomy .

Psychotherapy may have an important role to play in the care of patients admitted to the hospital for stomach cancer surgery. Researchers randomly divided 271 surgical patients with cancers affecting the gastrointestinal tract ( esophagus , stomach , liver , pancreas , colon , or rectum) into two groups: one received usual care on the surgical ward and the other received formal psychological support in addition to usual care. Psychological interventions, which were provided both before and after surgery, consisted of emotional and cognitive support and help in planning for the future. Ten years after their surgery, patients who received psychological support were significantly more likely to be alive than those who did not receive such additional care.

Gastrectomy

A gastrectomy is the removal of all or part of the stomach. Gastrectomy is the only treatment that offers the hope of curing stomach cancer. However, it is only potentially curative if the cancer has not spread beyond the stomach; in other words, only Stages 0, I, II, or III may be cured through surgery.

Gastrectomy may also be done for palliation (symptom relief). It may help decrease bleeding or pain, even in patients with more advanced stages of stomach cancer.

There are three main types of gastrectomy operations:

  • Distal subtotal gastrectomy —This involves the removal of the part of the stomach closest to the intestine; some of the duodenum (first part of the small intestine) may also be removed. The remaining stomach is attached to the small intestine.
  • Proximal subtotal gastrectomy —In this procedure, the surgeon removes the part of the stomach closest to the esophagus. A portion of the esophagus may be removed at the same time. The remaining stomach is attached to the esophagus.
  • Total gastrectomy —The entire stomach is removed. A piece of intestine is then used to form a new holding pouch for food; this holding pouch is then attached to the esophagus.

Description of the Procedure

You will be given general anesthesia before you undergo a gastrectomy. An incision is made from your breastbone down to your navel. Depending on the type of operation you are having, part or all of your stomach is removed. If the stage of your cancer is such that you may be hoping for a cure, then your surgeon will also try to remove as many lymph nodes as possible from the area around your stomach, some of the fatty tissue in your abdomen, and the spleen.

Your hospital stay will last about a week. If you develop complications, you will have to stay in the hospital longer.

Effectiveness

Gastrectomy is the only treatment that offers any hope of a cure for stomach cancer. Survival following gastrectomy is related to the stage of the tumor and the administration of chemotherapy and radiation therapy afterwards.

In the United States, the five-year survival rate, as reported by the American College of Surgeons, is:

  • Stage I: 50%-80%
  • Stage II: 30%-50%
  • Stage III: 8%-40%
  • Stage IV: 7%
The use of adjuvant therapy (chemotherapy and radiation after surgery) is expected to improve the survival. Unfortunately, most patients are found to have locally advanced disease at the time of surgery (Stage II or III).

Possible Complications

Gastrectomy has a very high rate of complications and death; about 7% to 10% of all patients die in the immediate postoperative period. It’s important to find a surgical team that has a great deal of experience with these operations.

Possible complications include the following:

  • Bleeding
  • Blood clots
  • Damage to neighboring tissues or organs
  • Remaining cancer
  • Infection
  • Digestive juices leaking into the abdomen
  • Nutritional deficiencies
  • Inability to eat more than a small amount at a meal
  • Pernicious anemia —inability of the body to process vitamin B12 , requiring B12 shots for life
  • Dumping syndrome—foods pass into the small intestine too quickly, causing symptoms such as sweating, dizziness, nausea, vomiting, diarrhea

Postoperative Care

Since this is a major operation, you may have the following postoperative care and medical support:

  • Nasogastric tube—This is a tube that passes through your nose into the remaining part of your stomach in order to drain accumulating digestive juices. The tube will stay in place for several days until your intestine is functioning normally again.
  • Feeding jejunostomy tube—This will be placed into the small intestine at the time of surgery. A liquid form of nutrition may then be administered through this tube until your oral intake is adequate to maintain your weight.
  • Intravenous (IV) fluids—These will be administered until you are able to drink sufficiently.
  • Antibiotics through the IV (if necessary)
  • Oxygen through a tube placed near your nostrils (if necessary)
  • A bladder catheter to drain your urine (if necessary)

Dietary Changes

Once your stomach and/or intestines are beginning to function normally, you will be allowed to drink liquids. Over the next day or days you will progress through a soft diet to regular food, as tolerated. You may need to consult a registered dietitian for help in choosing healthful foods and eating patterns that you can tolerate. Some suggestions may include:

  • Eating smaller meals
  • Eating more frequent meals
  • Avoiding a high intake of fat at any given time
  • Making sure that the calories you take in are as nutritious as possible
  • Utilizing dietary supplements if you are having difficulty maintaining good nutrition

If you have dumping syndrome, you may need to make dietary changes, such as decreasing your intake of sugar-containing foods and increasing your protein intake. Symptoms of dumping syndrome include diarrhea, cramping, nausea, vomiting, sweating, and dizziness after eating. If you have these symptoms, contact your doctor right away.

Revision Information

  • Cecil Textbook of Medicine. Philadelphia, PA: WB Saunders Company; 2002: 738-741.

  • Conn’s Current Therapy 2002. Philadelphia, PA: WB Saunders Company; 2002: 527-529.

  • Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on poor survival of US gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer staging, proximal disease, and the "different disease" hypothesis. Cancer. 2000;88:921-932.

  • Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1,038 patients. Ann Surg. 2000;232:362-371.

  • Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Philadelphia, PA: WB Saunders Company; 1998: 733-749.

  • What is stomach cancer? American Cancer Society website. Available at: http://www.cancer.org/ . Accessed December 2002.

  • What you need to know about stomach cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancerinfo/wyntk/stomach . Accessed December 2002.

  • 9/18/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Küchler T, Bestmann B, Rappat S, Henne-Bruns D, Wood-Dauphinee S. Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10-year survival results of a randomized trial. J Clin Oncol. 2007;25:2702-2708.