Gastrectomy
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
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.
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 subtotal gastrectomy is performed, meaning that a small portion of stomach will be left behind. If the tumour is a higher up, a total gastrectomy will be performed, meaning that the entire stomach is removed.
The lymph nodes are taken out with the stomach. These are found along the blood vessels that supply the stomach. 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 and it stage.
After removal of the stomach, the small bowel needs to be joined onto the remaining upper part of the stomach (subtotal gastrectomy) or onto the oesophagus (total gastrectomy) to restore continuity to your gastrointestinal tract.
Recovery
Following a gastrectomy a short stay in the Intensive Care Unit (ICU) is common. 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. 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.
Follow Up
Dr Gillespie will see you in rooms 2-4 weeks after your surgery. By this time, you should feel well on the road to complete recovery. There may be a need for further cancer treatment, for example chemotherapy.
This appointment is an opportunity to further discuss your pathology results and how you are progressing since you left hospital. Weight loss is common post procedure and we will also discuss your nutrition.
The Patient Journey
Book an appointment
Call or email Dr Gillespie’s rooms to book an appointment. You will need a referral from your GP or specialist if you would like a Medicare rebate.
First Consult
You'll meet with Dr Gillespie to discuss your symptoms, history and diagnosis.
We encourage bringing a support person to these appointments as there is often a lot of new information discussed.
We also encourage writing down any questions before you attend this appointment.
Work up
Any new cancer diagnosis requires a full workup for staging. Dr Gillespie will discuss what is needed in your specific case and organise any further imaging (eg CT and/or PET), endoscopy or laparoscopy.
Multidisciplinary team meeting
This is a meeting attended by medical oncology, radiation oncology, radiology, gastroenterology, pathology and surgeons. Each case is discussed in detail and a treatment recommendation is agreed upon.
Further appointments
After MDT, Dr Gillespie will generally discuss with you the ongoing plan. You may need to see (or will have already seen) a medical oncologist or radiation oncologist.
Surgery
If you have chemotherapy beforehand, surgery will usually be four weeks after completion.
You will be admitted to hospital for a minimum of 5 days following the procedure.
After discharge
You may need a period of rehabilitation following surgery. This will be organised from hospital.
We will keep a close eye on your nutrition and a dietitian appointment can be organised for you.
Follow up
Dr Gillespie and the oncology team will follow you up closely for two years after your treatment, and then ongoing to five years.
Pathology
Depending on your treatment plan and pathology, further chemotherapy and/or radiotherapy may be required.