Stomach cancer surgery with either a full or partial gastectomy can be curative although there are potential risks to this form of treatment and complications can arise.
The type you have really depends on where the tumor is and the stage of your disease.
It is these two parameters which determine your chance of a cure. It also depends on whether you are fit to have an anaesthetic as well as the procedure itself.
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In most centres, fitness is normally determined by the surgeon and the anaesthetist. In a lot of centres, a pre-assessment clinic is used where certain measurements can be used.
Your history will be taken of past medical and surgical conditions that may increase your risk of complications, the drugs you may be taking, your smoking and alcohol history relevant to your anaesthetic.
You will be examined and certain measurements will be taken including pulse, blood pressure, urine tests and x-rays.
If you have breathing problems further investigations such as spirometry (a breathing test) may be made and subsequent referral to the anaesthetist for assessment.
Equally, if you have heart problems you may need assessment by a cardiologist to make sure that you are fit enough for the operation.
Removal of the stomach is known as a gastrectomy. During this procedure, your surgeon will also remove surrounding lymph nodes to make sure that your cancer hasn't spread as well as to stage your disease accurately.
It can be performed either as an “open” procedure or traditional operation with a large incision or subsequent scar. However, the procedure is now more commonly performed laparoscopically or as a “keyhole” procedure.
Laparoscopy involves the insertion of instruments through the abdominal wall through very small incisions. To allow visualisation of your abdomen, carbon dioxide is used to inflate your inner abdomen.
The instruments are specifically designed to allow this form of procedure, with images projected on to monitors the surgeon can see.
There are many advantages of a laparoscopic procedure. The scar is a lot smaller so there is less likely to be as much pain after your operation.
With laparascopic gastrectomy, you are likely to be up on your feet quicker with a reduced hospital stay in comparison to an open procedure.
Internal scarring or “adhesions” are less likely with laparoscopy and potentially less risk of damage to your internal organs and reduced bleeding risk.
However, "keyhole surgery" is not always possible and sometimes your laparoscopy has to be turned in to an "open procedure" if complications arise which can’t be remedied via the keyhole approach.
The type of operation really depends on where your tumor is:
If your tumor lies in the distal or lower end, a partial gastrectomy or removal of the lower end is normally undertaken.
This form of stomach cancer surgery involves cutting away the lower end and the connection of your small bowel to the remnant left.
This form is known as a Roux-En-Y procedure and you can see how this is done in the picture below:
This form has the advantage of maintaining the connection between the upper stomach and your esophagus, gullet or food pipe.
It is this area that helps to prevent reflux of bile and any remaining gastric juices in to your food pipe so you are less likely to have severe reflux symptoms of heartburn and indigestion.
You are also less likely to develop structuring in the esophagus from long term reflux.
If your growth lies in the upper portion, a full gastrectomy or removal of your whole organ is usually required.
If the cancer is very high and involves the very low part of your esophagus, part of this may need removing too.
In this form of stomach cancer surgery, your surgeon will perform a gastrectomy and attach your small bowel or jejunum to your food pipe.
The duodenum or first bit of your small bowel remains as your bile duct and pancreas empty in to this area of your bowel. To allow this to continue, the duodenum is connected to your jejunum as outlined in the picture below:
With this form of stomach cancer surgery, the mechanism for preventing reflux is lost. This can result in the passage of bile and small intestinal juices in to the food pipe.
As a result, inflammation and stricturing or narrowing of the food pipe can occur later on which can affect your swallowing ability.
You may require endoscopic treatment for this as well as drugs to reduce the amount of reflux.
This is a large topic in its own right. I have produced plenty of diet information and you can read more about this by going to my diet after gastrectomy page or why not purchase my book about diet following gastrectomy packed full of information about this.
With any form of surgery there are always risks and complications that can arise.
There are also long consequences too. Follow the link if you would like to find out more about "what to expect after cancer surgery"
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