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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. 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, get blood clots, 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.
  
  
• 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.

GETTING READY:

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Your caregiver may teach you things you need to know about your condition. He will tell you what to expect and what you need to do before and after your surgery.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• You may need to have your blood and urine tested. Imaging tests, such as x-rays, computerized tomography (CT) scan, or other tomography may be done. A positron emission tomography scan is also called a PET scan. It is a test used to look at different parts of your body to see how they are working. A PET may be done by caregivers to find cancer cells in your body. Sample tissues from your tumor may be taken and sent to a lab for tests. You may also need procedures before your surgery, such as endoscopy, endoscopic ultrasound, or laparoscopy. Ask your caregiver for more information on other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Remove any nail polish.
  
  
• You may be given medicine to help you sleep.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• Ask caregivers about directions for eating and drinking.
  
  
• You may be given an enema to empty your bowel before surgery.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What will happen:

• You will be asked to change into a hospital gown. You may be given antibiotic medicine through your intravenous (IV) tube to prevent an infection. You may be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the operating room. General anesthesia medicine will be given to keep you asleep and control pain during the surgery. You will be placed lying on your back. Your chest and abdomen (belly) will be cleaned and then covered with sheets.
  
  
• During your surgery, an incision (cut) will be made on your abdomen. Your caregiver will carefully cut through or push 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 will connect your esophagus or the remaining stomach to your small intestine (bowel). He will check around for other tumors and damage, and stop any bleeding. A drain (thin tube) may be placed to empty fluids or blood from your abdomen. The incision will be closed with sutures (stitches) or staples, and will be 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 try to get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken to your hospital room. The bandages covering your incision will keep the area clean and dry to prevent infection. A caregiver will remove the bandages soon after your surgery to check your wound.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your surgery appointment on time.
  
  
• You get sick (a cold or flu), or have a fever.
  
  
• You have an infected skin or wound near the area where your surgery will be done.
  
  
• You have questions or concerns about your surgery.

SEEK CARE IMMEDIATELY IF:

• You have severe (bad) pain in your abdomen, or feel faint or weak.
  
  
• You have trouble breathing or chest pain all of a sudden.
  
  
• You throw up after having small amounts of food or liquids.
  
  
• You are throwing up blood.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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.

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