Background Information:

What are the other Names for the Procedure?

• Partial Gastrectomy for Gastric Cancer
• Stomach Cancer Surgery
• Subtotal Gastrectomy for Gastric Cancer

What is the Surgery for Stomach Cancer surgical procedure?

Surgery for Stomach Cancer is a surgical procedure that involves removal of abnormal cancerous tissue within the stomach.

What part of the Body does the Procedure involve?

The Surgery for Stomach Cancer procedure involves the stomach, small intestine, and occasionally the esophagus.

Why is the Surgery for Stomach Cancer surgical procedure Performed?

A Surgery for Stomach Cancer procedure is performed for stomach cancer (also known as gastric cancer).

What are some Alternative Choices for the Procedure?

Anti-cancer drugs (chemotherapy) may be used; however, when indicated and possible, a surgery is the best option.

What are the Recent Advances in the Procedure?

Minimally-invasive surgical techniques have undergone further improvement and refinement.

What is the Cost of performing the Surgery for Stomach Cancer surgical procedure?

The cost of Stomach Cancer Surgery procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Stomach Cancer Surgery procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.cancer.org/cancer/stomachcancer/overviewguide/stomach-cancer-overview-treating-surgery (accessed on 05/12/2015)

Prior to Surgery for Stomach Cancer surgical procedure:

How is the Surgery for Stomach Cancer surgical procedure Performed?

The Surgery for Stomach Cancer procedure is performed under general anesthesia. Depending on the type and size of the cancer, one of the following surgical procedures may be used:

Endoscopic Resection procedure:

• It is performed in very early cancers
• The surgeon passes an endoscope (tube fitted with a camera) through the food pipe and into the stomach to visualize the cancer
• The cancer is cut and removed using special surgical instruments that can be passed along with the endoscope

Subtotal Gastrectomy procedure:

• It is performed in cancers that are limited to either the upper or the lower portion of the stomach
• The surgeon makes an incision on the skin of the abdomen and cuts through the layers to visualize the stomach
• After cutting off the blood vessels to the affected portion of the stomach, the diseased part of the stomach is removed. The surgeon may also remove a portion of the food pipe or the intestine if it has been affected by cancer. The surgeon may also remove the lymph nodes that may be cancerous
• The healthy ends of the gastrointestinal tract are then sutured together
• After ensuring that there is no bleeding, the abdomen is closed in layers

Total Gastrectomy procedure:

• It is performed for cancers that involve a large portion of the stomach
• The surgeon makes an incision on the skin of the abdomen and cuts through the layers to visualize the stomach
• After cutting-off the blood vessels to the stomach, it is removed completely
• The surgeon may also remove a portion of the food pipe or the intestine if it has been affected by cancer. Portions of nearby organs, such as the pancreas or spleen, may also be removed. The lymph nodes that may be cancerous are also removed
• The healthy end of the food pipe is sutured to the intestines
• After ensuring that there is no bleeding, the abdomen is closed in layers
• In some instances, it may be possible to perform the surgery using minimally-invasive surgical techniques (laparoscopically by making multiple small incisions on the abdomen, so as to introduce a laparoscope - a tube fitted with a camera and special surgical instruments)

Where is the Procedure Performed?

Surgery for Stomach Cancer is performed in a hospital.

Who Performs the Procedure?

A general surgeon performs the Surgery for Stomach Cancer procedure.

How long will the Procedure take?

The Surgery for Stomach Cancer procedure may take over 2-3 hours to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Surgery for Stomach Cancer and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Surgery for Stomach Cancer using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Surgery for Stomach Cancer surgical procedure?

Before a Surgery for Stomach Cancer, the patient has to undergo certain tests such as:

• Routine blood and urine analysis
• X-ray of the gastrointestinal tract
• Chest X-ray
• Electrocardiography (ECG)
• Endoscopy
• Computerized tomography (CT) scan

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Surgery for Stomach Cancer procedure?
• What does the removal procedure involve?
• Why is this procedure necessary?  How will it help?
• Will the procedure in any way impair my mobility?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• What are the costs involved?

During the Surgery for Stomach Cancer surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation are administered for this procedure.

How much Blood will you lose, during the Procedure?

Some amount of blood loss may be expected during the more intensive gastrectomy procedures, and transfusion may be needed.

What are the possible Risks and Complications during the Surgery for Stomach Cancer surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Surgery for Stomach Cancer are:

• Excessive bleeding
• Infection within the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Surgery for Stomach Cancer surgical procedure?

• After the Surgery for Stomach Cancer procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
• The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
• Individuals are usually discharged from the hospital about 10-14 days after the surgery is performed

After the Surgery for Stomach Cancer surgical procedure:

What are the possible Risks and Complications after the Surgery for Stomach Cancer surgical procedure?

The possible risks and complications that may arise after Surgery for Stomach Cancer are:

• Excessive bleeding
• Excessive diarrhea
• Infection within the surgical wound
• Malnutrition
• Partial paralysis of the stomach (gastroparesis)
• Ulcer disease
• Incisional hernia

What is the Prognosis after the Surgery?

The prognosis after surgery depends on the stage at which the cancer was operated on and any other related factors. Early stages of stomach cancer carry a better prognosis than advanced disease.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
• Signs of an infection
• Headache, muscle aches
• Fever, feeling sick
• Dizziness
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Surgery for Stomach Cancer surgical procedure?

At home, the following post-operative care is recommended after the Surgery for Stomach Cancer procedure:

• Slowly resume regular/daily activities as early as possible, which aids in faster recovery
• Use a heat pad or warm compress to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with mild, unscented soap
• Replace the dressing after showering
• Elevate legs, while resting, to prevent the formation of blood clots and reduce the possibility of swelling
• Complete the course of prescribed medication, as advised by your physician
• Take stool softeners to prevent constipation, as advised by your physician
• Take antibiotic medication to help combat or prevent infection, per your physician’s advice
• Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
• Avoid all activities that are physically strenuous for about 6 weeks after surgery
• Resume driving only 3-4 weeks after being discharged from the healthcare facility, per your physician’s advice
• Avoid sex until a complete healing has taken place (under advise by the physician)

How long does it normally take to fully recover, from the Procedure?

Complete recovery from the gastrectomy procedure may take up to several weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Surgery for Stomach Cancer surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist
• A pathologist
• General surgeon

The patient is advised to inquire and confirm the type of billing, before the Surgery for Stomach Cancer procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA