Gastrectomy – surgical treatment of the stomach
Removal of the stomach or gastrectomy (gastrectomy) is a manipulation to remove the entire organ for therapeutic purposes. The continuity and functioning of the gastrointestinal tract are further ensured by the connection of the esophagus with the intestines. This extensive operation is performed for life-threatening indications, often for stomach cancer. After the removal of the organ, for the functioning of the digestive system, a person must follow the diet and rules of nutrition.
What is a gastrectomy?
The term indicates an intervention with complete, total removal of an organ. When excising a part of an organ, doctors use the term gastric resection.
Gastrectomy is prescribed as a radical method of treating oncology, non-healing extensive gastric ulcers, wounds, or perforation of the organ. There are modifications to removing the stomach when the stomach is removed partially or completely during a gastrectomy.
The term includes several operations:
- Subtotal gastrectomy. It removes the part of the stomach affected by the malignant process, neighboring lymph nodes, and sometimes other internal organs near the tumor. The technique is applicable for the first and second stages of cancer.
- Total gastrectomy. It consists of the complete removal of adjacent lymph nodes, sections of the esophagus, and small intestine. After the operation, the stomach is directly connected to the small intestine. Interventions of such a plan are carried out only when other methods are ineffective when the oncological process is started; the third or last fourth stage of oncology is diagnosed.
- Access to the operation site can be laparotomy (through a wide incision in the abdominal cavity) or laparoscopic (through several punctures in the abdomen). The optimal tactics are selected depending on the expected scope of work. Sometimes, when mistakes are made during the diagnosis and the minimally invasive method does not allow the removal of the pathological part of the stomach, laparoscopy turns into laparotomy.
Indications and contraindications
Total gastrectomy is indicated for patients with gastric cancer. The intervention can be carried out if the tumor grows into the muscle membranes and does not allow the stomach to perform the functions assigned to it, threatening life. The main goal is to prolong the patient’s life while maintaining quality.
The list of indications for gastrectomy includes:
- tumor lesion with localization in the proximal part, accompanied by damage to the esophagus or without it;
- a tumor located in the body of the stomach;
- small cell carcinoma (complete removal is shown);
- recurrent cancer on the stump.
The intervention has several contraindications:
- spread of metastases throughout the body, including to distant organs;
- the disease is accompanied by renal, hepatic, respiratory, or heart failure;
- pathological processes cover the hematopoietic system.
In the presence of contraindications, intervention is meaningless. If the work of important internal organs or systems is disrupted, the patient will not undergo the operation. Metastasis to distant organs is an indication for providing palliative therapy to prolong the patient’s life, maintain its quality, and eliminate pain.
When is an organ removed for cancer?
It is often impossible to do without surgery, even if cancer is detected early. Surgical treatment is the most effective in this pathology.
If possible, doctors will try to remove as little tissue as possible to save the organ by removing part of it. Such a decision is made after a thorough diagnosis and assessment of the disease’s recurrence risks.
It is not always possible to save an organ. Endoscopic resection of the stomach to excise a tumor with affected tissues is possible only at an early stage of the disease. If the doctor realized that it was impossible to save the organ during the diagnosis, the patient should agree to its partial or complete removal. Procrastination in the case of oncology is dangerous; the situation can worsen every day.
Types of operations for stomach cancer
In oncological pathologies of the stomach, open and laparoscopic operations are performed. Open access involves an incision in the anterior abdominal wall along the abdomen. Such wide access provides the surgeon with complete penetration of the stomach and other organs. In laparoscopic intervention, the surgeon works through small punctures in the abdominal wall using endoscopic instruments.
Operations also differ in terms of the volume of excised tissues of the organ:
- Resection of separate parts of the stomach. It is used at the initial stage of tumor formation when the neoplasm does not metastasize. Removed from 30 to 60% of the volume of the stomach.
- Subtotal resection. It is carried out at the lower localization of the neoplasm. At least 75% of the volume of the stomach is removed, and the lymph nodes are also subject to excision.
- Total resection. The stomach is completely removed, providing direct communication between the duodenum and the esophagus. Sometimes it affects neighboring organs, the spleen, and pancreas. Lymph nodes are subject to mandatory excision.
- There is another type of intervention for stomach cancer – palliative. It detects pathology at the final fourth stage when cancer is accompanied by metastatic foci spread to distant organs. The purpose of the intervention is to ensure the passage of food. A stent is often installed, which creates the necessary clearance for the passage of food.
What is the best access?
Laparotomy or laparoscopy cannot be called the optimal solution for tumor excision. The method is selected depending on the location of the malignant tumor and the patient’s individual characteristics. The surgeon chooses an operating mode that guarantees sufficient visibility to maneuver and perform the operation technically correctly. This is necessary to avoid complications. Most often, laparoscopy is used for early cancer. The more complex the situation, the more access will be required.
Gastrectomy is a planned operation; therefore, before it is performed, the patient undergoes preparation. When making an appointment with an oncologist, the nearest time for examination is determined, and the phone number for communication and personal data are specified. Mandatory diagnostics include the following methods:
- general blood test and its biochemistry;
- Analysis of urine;
- X-ray examination of the chest;
- X-ray with the use of a contrast agent;
- CT and MRI according to indications.
Before excision of the stomach for cancer, radiation or chemotherapy is mandatory. Such treatment is necessary to stabilize the work of vital organs. Twelve hours before the intervention, a cleansing enema is performed, after which the patient cannot eat; you can drink water to a limited extent.
Stages of intervention
Regardless of the chosen method, the intervention is performed under general anesthesia. Before the operation, the anesthesiologist will conduct a detailed conversation to determine the anesthetic allowance. After immersing the patient in anesthesia, the surgeon incisions the abdominal cavity. Removal is most often achieved laparoscopically. Before removal, a complete audit of the organs is carried out. The procedure allows you to establish the severity of the spread of the disease and the presence of metastases. Depending on the condition, the practicality of gastrectomy is determined.
During the operation for a malignant process, lymph nodes are removed, and tissues adjacent to the tumor are widely excised. Excised materials are sent for biopsy and histology.
After the removal of the organ, an anastomosis is removed to restore the integrity of the digestive tract. If the length of the esophagus is not enough to create a message between the organs, it is replaced by a section of the jejunum. At the end of the manipulation, the intestinal loops are fixed, the peritoneal organs are re-examined, and the tissues are sutured.
Recovery after surgery
The operation is performed after the patient is admitted to the hospital. After a minimally invasive intervention, recovery is short, it takes no more than a week, and a patient can be discharged from a medical institution on the second day. When performing an open access intervention, discharge should not be expected early. Within 7-14 days, doctors will monitor the patient’s condition.
In the first two days, the intake of any food is prohibited. Nutrients are administered intravenously. Further, this process is provided by a gastric tube. Only on the 5th day, the menu includes grated meat and vegetable dishes, cereals, and curd mass. The return to normal life occurs at least six months later; most often, it takes more time – 1‒1.5 years.
Features of digestion after resection
Food intake is prohibited during the first two days, and the patient is shown a therapeutic and restorative zero diet. After its observance, you can gradually restore the familiar menu if it is portable.
The patient must understand that after gastric resection, it will be necessary to significantly reduce the volume of portions, eat during the day, but in small volumes, and revise the composition of the menu. It is necessary to adhere to this rule because the stomach after gastrectomy decreases in volume or is completely absent, and food enters the intestines. The digestion process is disturbed because the food bolus is deprived of natural processing by the stomach. The intestine cannot fully compensate for the missing function, but after 1-1.5 years, it can adapt to absorb nutrients.
During the operation, nerve trunks are crossed, which leads to an imbalance in the coordinated work of different parts of the gastrointestinal tract. Therefore, symptoms of indigestion (vomiting, diarrhea, pain) with general autonomic reactions (dizziness, weakness, increased sweating) are not excluded. Such complaints are typical for dumping syndrome of varying severity.
Diet after surgery
Proper nutrition after surgery to remove the stomach or part of the cancer is the key to a successful recovery. Proteins form the basis of nutrition for a speedy recovery and a set of necessary daily calories.
The diet includes several postoperative stages:
- in the first few days, the patient is forbidden to eat;
- then crushed food, decoctions, tea, and purified water are introduced;
- normalization of nutrition – the patient switches to regular food with some restrictions.
The patient menu after surgery can include:
- slimy soups with cereals without potatoes;
- lean meat and poultry (passed through a meat grinder);
- dairy and egg casseroles;
- white fish;
- boiled vegetables;
- freshly squeezed diluted juices from non-acid fruits.
- concentrated broths;
- freshly baked bread;
- fatty, smoked, salty;
- fatty dairy products;
- sour fruits;
- sausages and other mechanically processed meat;
- hard and processed cheese;
- strong tea and coffee;
- all sauces and dressings.
Like any operation, gastrectomy is dangerous for its complications. Their list includes:
- profuse blood loss;
- the formation of a peptic ulcer in the fistula zone;
- violation of the formed anastomosis;
- dumping syndrome.
Such complications are rare; they may be associated with the patient’s severe condition before the intervention.
After performing the resection, the patient is transferred to the hospital. Hospitalization lasts from 2 to 3 weeks, depending on the recovery speed. The rest of the period can be spent at home, under the supervision of loved ones. In the first two days, the patient is shown on bed rest; nutrients are administered intravenously. The transition to semi-liquid food is gradually provided. Full recovery takes more than six months. During the first two weeks, it is shown to wear a bandage and limit physical activity. All information on recovery is explained to the patient before discharge; he can always seek help from a doctor.
Quality of life after gastrectomy
The quality of life after the intervention remains at a sufficient level; there are some dietary restrictions. 2-3 years after gastric resection for cancer, the patient will be able to return to a normal diet. This is the case with partial gastrectomy for gastric cancer. If the stomach is completely removed and the esophagus is directly connected to the small intestine, gastrointestinal disturbances will occur during the first year of recovery, including problems with defecation. It is not excluded the appearance of indigestion, weakness, or significant weight loss.