What is the stomach?
The stomach is a dilated segment of the digestive tract located between the esophagus and the duodenum. Its main function is to transform the food bolus into a mixture called gastric chyme.
The stomach is connected to various organs of the abdomen by ligaments: to the liver by the hepato-gastric ligament, to the spleen by the gastro-splenic ligament, to the colon by the gastro-splenic ligament and to the diaphragm by the gastro-splenic ligament. -phrenic.
The stomach performs a dual function: the start of digestion and the progression of the food bolus towards the intestine.
Role of surgery (gastrectomy) in the treatment of a stomach tumor?
Stomach cancer has been discovered in you. Then an operation is the only possibility. Surgery is the main treatment for stomach cancer. It makes it possible on the one hand to cure this cancer by completely removing the tumor and on the other hand to relieve the symptoms induced by the presence of this tumor (occlusion, pain, bleeding).
The type of surgery performed depends mainly on the type of tumors (cancer, endocrine tumor, stromal tumor, GIST), the size of the tumor, its location. The side effects of surgery depend on the type of surgery performed.
What is your course of care during surgery (gastrectomy) for a stomach tumour?
It is important to know that different doctors practicing in different disciplines (surgeon, anesthesiologist, gastroenterologist, cardiologist, oncologist, radiologist, radiotherapist, pathologist) will work as a team to ensure your treatment, this is called multidisciplinary treatment.
This guarantees the meeting of all the essential skills for your treatment to be optimal. You will therefore be put in contact with different doctors during your treatment.
The choice of the type of treatment as well as the prognosis (chance of recovery) depends on the situation and the evolutionary stage of the malignant tumour: is it the stomach lining that is affected or the entire wall? Are there extensions in neighboring tissues or in distant tissues (lymphatic node, liver, lungs, …)?
What type of tumor is it? What is his size ? What is your state of health? To determine all this, additional examinations will be carried out such as a CT scan, a colonoscopy, an additional blood test, etc.
After discussion by the multidisciplinary team, your doctor will discuss the results of these various examinations and the follow-up for your treatment with you. It is possible for you to bring a member of your family during this information of the results. The results of the examinations provide information on the nature and extent of the condition. This does not presage consequences and evolution. The results of the various examinations make it possible to determine the optimal methods of your care, and this according to the recommendations of care issued by the health authorities.
Thus the team taking care of you may suggest that you carry out radio-chemotherapy before surgery (we speak of neo-adjuvant radio-chemotherapy), or chemotherapy before surgery (we speak of neo-adjuvant chemotherapy) or immediate surgery, sometimes followed by additional treatment with chemotherapy (called adjuvant).
How to prepare for stomach surgery (gastrectomy)?
Communicate your personal treatment to your surgery and find out about the medications that must be stopped or on the contrary continued for the intervention. Don’t forget to mention drugs as innocent as Aspirin or osteoarthritis drugs because they can increase the risk of bleeding.
If you are allergic to very particular drugs (for example Iodine, Aspirine, antibiotics, etc), you must announce it to your surgeon and to the anesthesiologist.
You will meet the anesthesiologist. He will answer all your questions about anesthesia.
Stomach cancer surgery is a difficult operation that can be exhausting and difficult to recover from, so you need to be as healthy as possible. A nutritional assessment to know the weight of the person as well as a dietary survey will be carried out and nutritional supplements or be fed by tube or intravenously in order to regain weight and improve their nutritional status and health.
How is stomach surgery performed?
For an intervention on the stomach you must be hospitalized and the operation is carried out under general anesthesia.
The operation is performed through a classic incision in the abdomen (or laparotomy). Your surgeon will use the technique which in your case seems the most appropriate and the safest.
There are many types of stomach operations possible. Your surgeon will discuss with you the type of procedure they are likely to perform.
During the operation the part of the stomach where the tumor is located is removed with the widest possible safety margin (passing away from the tumor) which may require the removal of the entire stomach. Then the intestine is brought back into continuity by suturing (with needles and threads or by means of an automatic suturing device called a stapler). An intestinal suture is called an anastomosis.
Whatever the type of operation that will be performed at home by the surgeon, he will remove in addition to the diseased intestinal segment the surrounding fatty tissue which contains vessels in which there are lymph nodes to reduce the risk of recurrence of the tumor in the surgical field. This also determines the proportion of stomach that will be removed.
It may also be indicated to remove part or all of another organ at the same time or if they are affected by the tumor (liver, small intestine, urinary tract, ovaries or spleen). This is not always easy to determine with certainty before the operation.
In more advanced cases the operation can take on a palliative nature, which means that the operation does not bring the cure but aims to reduce the symptom due to the tumor (occlusion, hemorrhage or bleeding)
Several interventions are therefore possible:
During an exploratory laparoscopy, the doctor inserts a laparoscopy into small incisions made in the abdomen. This is sometimes used to see if the cancer has spread from the stomach to other parts of the abdomen (liver or pancreas for example). During this procedure, the doctor may detect smaller tumors that were not observed during imaging tests. The results of exploratory laparoscopy help the doctor decide what type of surgery is needed.
Gastrectomy is the surgical removal of part or all of the stomach through an incision made in the abdomen. The person is under general anesthesia during the operation. Gastrectomy is the most common surgery to treat stomach cancer.
There are different types of gastrectomy. The type chosen depends on the location of the tumor in the stomach and the stage of the cancer.
A total gastrectomy is used if the tumor is in the middle or upper part of the stomach. This surgery removes:
The whole stomach.
The lower part of the esophagus.
The first part of the duodenum.
Part or all of any nearby organ, such as the pancreas, spleen, or liver, into which the gastric tumor has spread.
The lymph nodes that surround the stomach, near the tumor area.
The digestive tract is then reconstructed:
The remaining part of the duodenum is separated from the jejunum while it is still attached to the bile duct coming from the liver and the pancreatic duct coming from the pancreas.
The jejunum is attached to the remaining end of the esophagus.
The remaining part of the duodenum is attached well below where the esophagus and jejunum attach (Roux-en-Y loop shunt).
this allows bile and pancreatic juices to enter the digestive tract without damaging the remaining part of the esophagus.
Lymph node dissection:
During surgery, the lymph nodes closest to the stomach, in the area near the tumor, are removed. Usually up to 15 lymph nodes are removed for examination. This is called D1 lymph node dissection. This is the lymph node dissection most often performed for stomach cancer.
Surgery may be used to relieve symptoms of advanced stomach cancer. Advanced stomach cancer can cause many problems including:
Inability to eat.
Obstruction (blockage): A tumor may block the way food enters or passes through the stomach, causing nausea, vomiting, or bloating.
Perforation: A tumor may break through the wall of the stomach, creating an opening in the abdomen.
The type of surgery done depends on the symptoms, the location of the stomach tumor, and the person’s overall health and nutritional status.
Surgery may be done to divert the flow of food or fluids around the gastric tumor that is blocking the stomach or esophagus. The part of the stomach that is above the blockage is cut off and then reattached to the small intestine. This allows food to pass through the stomach before reaching the small intestine.
A bypass surgery may be done if the person cannot have a gastrectomy due to health problems or if removing the tumor would not improve their quality of life.
How are the days following a gastrectomy?
After a few hours in the recovery room, you will return to your hospitalization unit for monitoring. Usually, this procedure responds well to painkillers.
Pain under the ribs or towards the shoulders may appear the day after the operation. They are due to laparoscopic gases. These pains always disappear in 24-48 hours.
We may be required to perform postoperative imaging to monitor the healing of the sutures.
In the days following the operation you can gradually resume drinks and then later liquid food and then solid food. We will remove the catheters that allowed us to hydrate you and calm your pain, the urinary catheter, and the drains.
You are given the first few days to drink and eat according to what your digestive system can tolerate. After this type of operation on the stomach, intestinal transit can be temporarily modified with, for example, diarrhea, more frequent needs or more difficult evacuation or constipation or even occlusion. Most often these phenomena are only transient and the functioning of the intestine normalizes. Sometimes, however, these abnormalities are more persistent and may require drug treatment.
Assuming that all of your stomach has been removed, you will need to have several small meals, because your feeling of satiety (disappearance of the feeling of hunger after a meal) will be quickly obtained. Vitamin supplements will also be needed.
When you leave (after 5 to 10 days of hospitalization in the absence of complications), pain medication will be prescribed, sometimes a home nurse will be needed and you will gradually resume your daily activities and light activity. A work stoppage of 4 weeks will be prescribed for you (taking into account the particularities of your work).
One month after the operation, you go to your post-operative consultation. Your surgeon will then authorize you to resume your physical and sporting activities.
What about after surgery (gastrectomy) for a malignant stomach tumor (cancer)?
The results of the microscopic examination of the surgical specimen will be communicated to you during your hospitalization or during the postoperative consultation after one month.
The results of the pathological examination provide information on the nature of the tumour, the type of cancer and its extension. This does not prejudge the consequences and the evolution. With these results additional treatment may be necessary.
Regular follow-up with clinical examination, blood test and scanner will be organised.
What to do in case of problems at home after a gastrectomy?
You must absolutely contact your surgeon in case of persistent fever, abdominal pain that resists the medication prescribed after the intervention, persistent nausea, vomiting, persistent cough or difficulty breathing, persistent difficulty in swallowing food, oozing of fluid through an incision.
Swelling in the old hernia area may appear after the procedure. It is generally a seroma, that is to say a pocket of liquid in the now empty area occupied by the hernia. This regresses within a few weeks. A hematoma encompassing the sex may also appear, it will disappear in about ten days (remember to put ice on the hematoma). If in doubt, do not hesitate to speak up.
When you leave, the documents provided by your surgeon and/or the department nurses include the telephone number of the surgery secretariat and the telephone number of the general practitioner on call (7 days a week, 24 hours a day) working at the Charcot clinic. (Lyon) he may, if he deems it necessary, hospitalize you. Do not hesitate to contact us.
Post-operative advice after gastrectomy
To ensure a speedy recovery, we draw your attention to a few important points. Resume very light activity, walking is permitted, avoid driving for 5 days. It is normal for the surgical area to be painful at first and will remain sensitive for some time. This should not prevent you from moving, walking and carrying out the acts of daily life.
During your recovery:
- It is advisable to take showers (the bath is to be avoided for a month).
- Do not carry heavy loads (for at least one month).
- In case of exposure to the sun, provide protection against UV (total sunscreen cream) the best solution is to wear clean clothing to cover the scar.
- Avoid practicing sport until the next consultation.
- Your anesthetist may prescribe subcutaneous injections to prevent phlebitis or pulmonary embolism.
- You have to leave the scars exposed. Most often there is no need to bring in a nurse.
- If threads are apparent on your scar they are absorbable, they can be wet and will disappear on their own. After your shower, pat the scars dry with a clean towel.
The food will be determined according to the intervention that was carried out and the particularities of your situation. You may need to fragment your diet by multiplying meals. All this information will be detailed to you when you leave by your surgeon, and a dietician can advise you. You may be prescribed vitamin supplements.
Smoking increases the risk of surgical complications. Quitting smoking 6-8 weeks before the procedure eliminates this additional risk. If you smoke, talk to your doctor, your surgeon and your anesthetist or call the Tobacco-Info-Service line at 39 89 to help you reduce the risks and put the odds in your favor.