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  • Surgery for stomach and oesophageal cancers

    Last reviewed November 2013

    Contents

    Surgery for stomach cancer

    Surgery may remove part or all of the stomach. The surgeon will try to leave as much of the healthy tissue as possible.

    There are three types of surgery for stomach cancer:

    • Endoscopic mucosal resection - early stage cancer is removed through a long, flexible tube (endoscope). Small areas of cancerous tissue can be removed leaving healthy tissue intact.
    • Subtotal or partial gastrectomy - the cancerous part of the stomach is removed, along with nearby fatty tissue (the omentum), lymph nodes and part of the oesophagus or small bowel, if necessary.
The stomach is then connected to the small bowel.
    • Total gastrectomy - the stomach is completely removed, along with the omentum, nearby lymph nodes and parts of nearby organs, as necessary. The surgeon will re-connect your oesophagus to your small bowel and the top part of this connection will take over some of the function of the stomach. Often a small tube will be placed further down the small bowel, coming out through the abdominal wall. This is to allow you to be fed while the join heals. The tube is usually removed after about six weeks or at your first post-operative out-patient appointment.

    The type of operation you have will depend on the location of the tumour and how advanced the cancer is. Your surgeon will explain the surgery that is best for you.

    After stomach surgery

    As with any major operation, stomach surgery has risks.

    Complications can include infection, bleeding, blood clots, damage to nearby organs or leaking from the connections between the oesophagus or stomach and small bowel.
      
    Your surgeon will discuss these risks or any other concerns you may have before the operation.

    Gastrectomy can also cause side effects, such as feeling too full after eating or drinking, dizziness or fainting, vomiting, continuous indigestion or reflux, swallowing difficulties (dysphagia), weight loss and malnutrition.

    Some people find it difficult to cope with dietary complications after surgery. Your health care team, including your surgeon, dietitian, speech pathologist and counsellor, can help you manage any side effects you experience.

    They can also advise you if these side effects are temporary or permanent and recommend ways to manage or reduce them.

    Surgery for oesophageal cancer

    If you have surgery for oesophageal cancer, you will be given a general anaesthetic and an incision will be made to your abdomen and chest and perhaps your neck. A tube may also be placed in your small bowel to help provide food while you recover from your surgery.

    There are three types of surgery for oesophageal cancer:

    • Oesophagectomy - the cancerous sections of your oesophagus are removed, along with lymph nodes and tissue, if necessary. The remaining part of the oesophagus is reconnected to the stomach.
    • Total oesophagectomy - a less common procedure where the entire oesophagus is removed. The surgeon pulls the stomach up and connects it to your throat or uses tissue from the large bowel to replace your oesophagus.
    • Oesopho-gastrectomy - parts of the stomach and oesophagus are removed at the same time. The remaining oesophagus is reconnected to the remaining stomach or tissue from the large bowel may be used.

    During the operation the surgeon may find the cancer cannot safely be removed. In this case they may stretch (dilate) the oesophagus or insert a tube of flexible mesh called a stent into your oesophagus. The stent expands the oesophagus to allow fluid and food to pass into the stomach more easily.

    After oesophageal surgery

    As with stomach surgery, operations on the oesophagus have risks.

    Complications can include infection, pneumonia, bleeding, blood clots or leaking from the connections between the oesophagus and stomach or bowel. Some people can experience irregular heart beats but this is usually temporary and settles within days. Your surgeon will discuss these risks or any other concerns you may have before the operation.

    You will feel short-term pain and tenderness around the area of the operation. This can be reduced with medication to keep you comfortable. Talk to your health care team about medication for pain.

    During your recovery you will probably be taught breathing or coughing exercises to keep your lungs clear. It is important you practice these exercises to reduce the risk of developing pneumonia.

    Some people experience reflux as a permanent side effect. You may be unable to sleep lying flat or you may experience reflux or gagging if you bend over too far. Most people are able to adapt to these changes by sleeping on a slightly inclined mattress or taking care not to overexert themselves.

    You may be able to eat normally, although your meal portion sizes will be smaller (i.e. you will get full with a smaller portion than before your operation). To maintain your nutrition you may need to eat more frequently, for example six half meals rather than three full meals a day. Discuss this with your health care team and you may be referred to a dietitian.

    Information reviewed by: Prof David I Watson, Head, Flinders University Department of Surgery and Head, Oesophago-Gastric Surgical Unit, Flinders Medical Centre, SA; Andrew Chester, Consumer; Jedda Clune, Senior Dietitian (Head & Neck and Upper GI Oncology), Sir Charles Gairdner Hospital, WA; Marion Draffin, Consumer; Carmen Heathcote, Cancer Council QLD Helpline Operator; Frank Hughes, Cancer Council QLD Helpline Operator; Dr Gregory Keogh, Upper Gastrointestinal Surgeon, Prince of Wales Hospital, NSW; and Meg Rogers, Nurse Coordinator: Upper Gastrointestinal Service, Advance Practice Nurse, Peter MacCallum Cancer Centre, VIC

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