Gastrectomy

WHAT YOU SHOULD KNOW:

• A gastrectomy is surgery to remove part or all of your stomach when you have cancer in it. The stomach is a hollow organ that breaks down food into nutrients (small pieces your body can take in). Your stomach absorbs (takes in) some nutrients and the rest then pass into your small intestine (bowel). Your stomach is connected to your mouth by a tube called the esophagus. You can get cancer in the upper or lower part of your stomach, or in all of it. Your caregiver will do a partial or total gastrectomy that is tailored to the location of your cancer. The path food travels may be changed with surgery, such as going from your esophagus into your bowel. Surgery may be done to remove the cancer, decrease pain and allow you to eat better, or both.
  
  
• Stomach cancer happens when abnormal cells grow and form one or more tumors in your stomach. The tumors can pinch blood vessels and nerves, and press on and damage nearby tissues. Cancer cells may break off from the stomach tumor and travel to other organs or body parts. Your surgery may also remove all or parts of nearby organs and tissues. These include your esophagus, lymph nodes, small intestine, spleen, pancreas, liver, and colon (large intestine). Caregivers may only remove tumors that give you severe (very bad) problems and leave other tumors behind. Your cancer problems, such as pain, bleeding, or weight loss, may or may not get better after surgery. Even when tumors are removed, they may come back or spread to other parts of your body.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may have an allergic reaction to the anesthesia medicine, and have trouble breathing. You could bleed more than expected, or get pneumonia or an infection. Incisions inside your body may not heal quickly, and food and liquids may leak out inside your abdomen. Without part or the whole of your stomach, you may not get enough nutrients from food. You may feel full after eating only small amounts of food. You may get dumping syndrome (loose watery stools that come soon after you eat) following your surgery. Even after surgery, tumors may return in your remaining stomach or to nearby organs and tissues. You may still get life-threatening bleeding or an infection and die.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• If you do not have this surgery, you likely will continue to have pain and lose weight. You may have eating problems, such as throwing up and feel full after eating small amounts of food. As the tumor gets larger, you may get a blockage that causes you to throw up all food. Your cancer can cause your stomach or nearby blood vessels to bleed so that you lose a lot of blood. Losing a lot of blood may cause you to have infections, breathing problems, or even die. Cancer cells can spread to other parts of your body, and grow into new tumors and cause damage. Cancer cells may reach your liver, and make it swell and cause you to have yellowish skin. Call your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During your surgery:

An incision (cut) is made on your abdomen (belly) to reach your stomach. Your caregiver carefully cuts through or pushes aside muscles and other tissues until your stomach is seen. Depending on your condition, your caregiver may remove the whole stomach, or leave a part of it. Sometimes he may only remove the tumor and a large part of tissue surrounding it. He connects your esophagus or the remaining stomach to your small intestine (bowel). He checks around for other damage and tumors which may have spread nearby, and stop any bleeding. A drain ( thin tube) may be placed to empty the fluid or blood from your abdomen. The incision is closed with sutures (stitches) or staples and covered with bandages.

After your surgery:

You may be taken to a recovery room, where you will stay until you are fully awake. Caregivers will watch you closely for problems. Do not attempt to get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages covering your incision keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Deep breathing and coughing: This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Medicines: You may be given the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicines: These types of medicines are given to decrease your pain after your surgery. You may need any of the following:
    
    
    • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.
      
      
    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
      
      
      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
        
        
      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
      
      
    • Patient controlled analgesia: You may get pain medicine from a special pump. You can receive the pain medicine through an IV or an epidural line. This is called patient controlled analgesia (PCA) or patient controlled epidural analgesia (PCEA). Your caregivers set up the PCA pump to give you small amounts of pain medicine. The PCA pump has a cord coming from it, with a push button on the end. When you feel pain and push the button, you will give yourself pain medicine. To keep you from getting too much medicine, there is a limit on how often you can get the medicine. Do not let anyone else push the button for you. Your pump may give you a constant dose of pain medicine, as well as the medicine that you give yourself. If your pain is still bad even with using the PCA, let your caregivers know.
  
  
• Monitoring: Caregivers may check for pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Gastrectomy (Inpatient Care)