A gastrectomy is performed for the surgical management of gastric (stomach) cancer. It involves the removal of the tumour with the stomach itself ensuring that the entire cancer is removed, along with removal of the lymph nodes that would typically be the first place that cancer would spread.
The procedure is performed under a General Anaesthetic and is often performed laparoscopically (keyhole), although open surgery is sometimes best to ensure safe removal of the tumour. First the surgeon will check that there is no spread of cancer outside of the stomach and nodes that are being removed. Assuming that this is all ok, the surgeon will proceed to perform the gastrectomy.
The stomach is freed up from all of the blood vessels that deliver blood to it. These arteries need to be carefully controlled by the surgeon to prevent bleeding. The stomach is then disconnected from the first part of the small bowel (duodenum) and from the oesophagus (food pipe). If the tumour is in the bottom part of the stomach, a distal gastrectomy is performed meaning that a short segment of stomach will be left behind at the top. If the tumour is a higher up, a total gastrectomy will be performed, meaning that the entire stomach is removed, and the oesophagus is left in place. Once the stomach is completely disconnected it can be removed.
The lymph nodes are taken out with the stomach. These are found in all of the fatty tissue that surrounds the stomach and the blood vessels that supply it.
The stomach and all of the lymph nodes are sent to the pathologist to be examined under a microscope to provide further information about the tumour.
After removal of the stomach, the small bowel needs to be joined onto the remaining upper part of the stomach (partial gastrectomy) or onto the oesophagus (total gastrectomy) so that food can make it all the way through.
Following a gastrectomy you will go to the High Dependency Unit (HDU) in the post operative period for close monitoring. Pain will usually be controlled with a self-controlled button (Patient Controlled Analgesia or PCA) to allow comfortable mobility. You will be mobilised early, especially after keyhole surgery. Often it may be necessary to use a nasogastric tube – a tube passing down your nose to your stomach passed at surgery – which keeps the join deflated. There may be a surgical drain coming through the abdominal wall. You will also usually have a catheter in your bladder. You will remain in hospital until you are eating adequately and mobilising comfortably.
Your surgeon will see you in the office around one month following your surgery. By this time, you should feel well on the road to complete recovery. There may be a need for further cancer treatment with chemotherapy depending on whether cancer was the reason for your gastrectomy and what the pathologist has found.
This appointment is an opportunity to further discuss your pathology results and how you are progressing since you left hospital.