Detection of gastric cancer in the patient serves as an indication for the appointment of a surgical procedure.
The decision on the operation is made based on the stage of the disease, the presence of secondary foci and a number of other factors associated with pathology. It is not necessary to refuse surgical treatment, because the operation carried out in time significantly prolongs the life of a person and shortens the general terms of recovery.
Indications and contraindications
Direct indication of gastric surgery is a malignant lesion of this organ.
The postoperative diet, carrying out before and after the surgical intervention of chemotherapy sessions and radiation irradiation is of great importance in complete recovery.
But not always surgery for stomach cancer can be prescribed, contraindications for its conduct are:
- Metastases detected in the liver, lungs, ovaries, douglas space, supraclavicular lymph nodes.
- Lesion of lymph nodes located in the distance from the stomach.
- Ascites.
- Cachexia.
- Cancerous peritonitis.
- Severe damage to the cardiovascular system, kidneys.
- Hemophilia.
The operation is performed in the absence of contraindications irrespective of the patient's age. Sometimes chemotherapy is preliminarily required, which leads to a reduction in the tumor and the possibility of its removal.
Diagnosis before
resection Before any kind of stomach surgery, a number of studies are necessarily assigned to patients with a cancerous lesion of this organ.
They are necessary for the elucidation of the functioning of vital organs, for an accurate explanation of the location of the tumor in the stomach, for the detection of all secondary foci.
Assign:
- Gastroscopy. This method of investigation reveals all the changes on the walls of the stomach, when it is performed, a biopsy is done, that is, the affected tissues are separated for histological examination.
- Computer tomography. This study shows the size of the tumor, its prevalence across all layers of the organ walls, the defeat of a number of organs and lymph nodes.
- Ultrasound scanning is necessary to identify secondary foci. The organs of the abdominal cavity, organs of the small pelvis, thorax are examined.
- General blood tests and biochemistry. According to the blood indicators, one can judge the activity of the inflammatory process, they are also necessary for assessing the performance of the liver, the heart, and the coagulating system of blood.
- ECG examination is performed to detect changes in the functioning of the heart. For certain violations, an appropriate treatment is required before the operation.
- Radiography of the chest.
Preparation measures
Before the surgery for the removal of a malignant tumor in the stomach, the preparation of the patient is necessary. Preoperative measures are carried out to improve the functioning of the most important organs, and with a view to improving the overall well-being of the person.
The patient needs to explain the advisability of adherence to a special diet. Foods a few weeks prior to surgery should be consumed primarily in a clean, easily digestible form. Food should be vitaminized, eat better in small portions.
The psychological preparation of the patient is also important. Not all doctors are inclined to have their patient immediately report a malignant lesion. Usually, the patient is told about the stomach ulcer, which, in order to avoid complications, urgently needs to be operated on.
The patient should be adjusted to a favorable outcome of surgical intervention, in this case his relatives can also show great help.
Drug medication for patients with gastric cancer before surgical treatment is:
- In the reception of vitamin complexes and products that improve the performance of the digestive system.
- In the use of sedatives that improve sleep and overall well-being.
- In transfusion of protein preparations and plasma, when a patient has severe anemia.
- In the appointment of funds that improve the functioning of the liver, kidneys, heart.
- In the treatment of antibiotics in detecting an increasing inflammatory response and an elevated temperature.
Before a stomach operation, it is recommended to rinse it repeatedly. This procedure is carried out with hydrochloric acid, a solution of furacilin, potassium permanganate. Rinsing removes food leftovers and releases the stomach from stagnation.
If there are signs of bleeding, haemostatic drugs are prescribed. Patients with cancer operations before the operation are often prescribed a course of metiluracil, this drug has anti-inflammatory properties, improves metabolic processes and liver function.
In gastric cancer, chemotherapy is often prescribed before the operation, their use allows to stop the spread of cancer cells through the body, leading to a stop of tumor growth.
Correctly performed preoperative preparation of patients with gastric cancer should ensure a reduction in the negative impact of pathology on the functioning of all organs, increasing the work of immunity and psychological training of a person.
Types of stomach operations for cancer
In oncology, several types of surgeries are used surgically to treat stomach cancer.
Choose them, based on the location of the tumor, the extent of its spread, taking into account the age of the patient, the presence of a number of metastases located.
- Resection of , that is, removal of one of the parts of the stomach with a tumor.
- Gastrectomy - complete clipping of the organ, in which parts of the intestine, esophagus and other structures are also removed.
- Lymphodiscussion - clipping of lymph nodes and vessels together with the surrounding fatty tissue. Removal of lymph nodes, in fact, is part of a full gastrectomy or resection of the stomach.
- Palliative surgery. This type of surgery is prescribed to facilitate the progression of the disease in patients with inoperable types of stomach cancer. Different techniques of operations are used.
The decision on the type of surgical intervention is taken after the doctor receives all the results of the examination of his patient.
Complete resection
Complete resection or total gastrectomy is clipping during the operation of the entire organ. It is prescribed if the cancerous growth grows from the middle part of the organ or affects all its parts. In addition to the stomach, the following is also removed:
- The omentum part is a peritoneal fold that holds the stomach.
- The pancreas is completely or metastatic-affected part of the organ.
- Spleen.
- Lymph nodes adjacent to the stomach.
After removal of the stomach, the upper intestine connects to the esophagus. The distal part of the duodenum is also brought to the intestine, which is necessary for casting enzymes that promote the digestion of food.
Total gastrectomy is a difficult operation, and after it is carried out, the patient must adhere to the recommended dietary guidelines. The maintenance of a postoperative diet depends on how the person will feel in the future, and how the recovery period will pass.
Laparoscopic gastrectomy
Laparoscopic surgery is a minimal intervention surgery. Currently, such treatment is possible with gastric cancer.
First, the surgeon makes a small incision on the abdominal wall of the patient, through which he enters the endoscope, with his help he examines the stomach itself and nearby structures with it. After the examination, a few more incisions are made, necessary for the introduction of surgical instruments.
Laparoscopic intervention can be performed with stomach cancer, both for partial organ removal and for its complete gastrectomy.
The removal of the stomach, its part, lymph nodes, and affected organs is cut off with a special surgical knife. Expansion of the abdominal cavity and better visibility of all internal parts of the body provides for the introduction during the laparoscopic intervention of carbon dioxide.
Image thanks to the camera on the endoscope is displayed on a large screen, the surgeon selects an enlargement of the image, which allows him to see all the changes and perform the operation with high accuracy.
Laparoscopic gastrectomy is less complicated than conventional surgery.
After such intervention, the patient is more tolerant of the rehabilitation period. But not always a laparoscopy can be prescribed, and in about three percent of cases when it occurs, it is necessary to switch to the usual surgical intervention for a number of identified changes.
Partial proximal
Partial proximal gastrectomy is administered when the neoplasm is located at the top of the organ.
It is rarely performed, because the detected tumor must meet a certain condition, it is:
- The dimensions of the lesion should not exceed 4 cm.
- The tumor growth should be exophytic.
- There should be no germination of cancer in the serous membrane.
Proximal resection involves not only clipping of the upper part of the organ, about 5 cm of the esophagus and lymph nodes are also removed. The operation is terminated by the formation of an anastomosis that connects the remaining stomach stump to the excised esophagus.
Partial distal
Partial distal resection is selected when a malignant tumor is diagnosed in the lower part of the stomach.
Simultaneously, lymph nodes, tumor-affected tissues and, if necessary, part of the duodenum are removed. The distal resection is completed by the formation of gastroenteroanastomosis, that is, the remaining part of the stomach is sewn to the jejunal loop.
Removal of lymph nodes
Regardless of what operation is performed with stomach cancer, removal of the lymph nodes is considered a prerequisite. In the lymph nodes accumulate and develop cancer cells, from where they can enter remote organs and tissues.
Palliative care for
The term palliative surgery refers to a surgical procedure undertaken to alleviate the symptoms of an oncological disease.
Some types of such operations are carried out to reduce the size of the cancers, which leads to a decrease in intoxication and allows for greater success in using chemotherapy and radiation.
Palliative surgery for stomach cancer is divided into two types:
- The first variant of surgical intervention involves creating a detour between the small intestine and the stomach. This improves the patient's nutrition, which positively affects his well-being and allows better transfer of further treatment. With this type of operation, the stomach can be removed, but the lymph nodes and cancerous tissues next to the organs are not affected.
- The second option involves the complete excision of the tumor , this is necessary to enhance the effect of radiotherapy and chemotherapy.
Palliative surgery is prescribed in neglected cases, and it allows to prolong the patient's life a little. There are also contraindications to palliative operations, this involves the bone system, mesentery, peritoneum, lungs, and brain in the oncology.
What is lymphadenectomy?
Lymphodiscussion in gastric cancer is a clipping of the lymph nodes and vessels adjacent to the organ along with the surrounding fatty tissue.
Lymphodissection differs in volume of removal, which depends on the stage of malignant lesion.
There are such types of lymph node cutting:
- D0 - lymph nodes in the surgical procedure are not removed.
- D1 - clipping of nodes located along and around the large curvature, next to the large and small stuffing box.
- D2 - removal of the above lymph nodes and nodes belonging to the second level.
- D3 - the lymph nodes located along the celiac trunk are additionally cut off.
- D4 - in addition to the above, the paraaortal nodes are cut off.
- Dn - removal of not only the lymph nodes, but also cancer affected by the organs next to the stomach.
The above options for the removal of lymph nodes are usually referred to as D1 lymphadenectomy. There is also another option, denoted by the term D2 lymphadenectomy, it implies and resection of groups of lymph nodes located next to the main blood vessels of the stomach.
This surgical intervention is considered to be more complicated by technique, but relapse of the disease occurs less frequently.
Rehabilitation
The minimum period of rehabilitation after removal of part of the stomach or organ in a cancerous tumor is at least three months. At this time it is very important to strictly adhere to all the recommendations of the doctor, this depends on the way a person lives in the future.
During recovery period in the first weeks it is impossible:
- To visit baths, saunas.
- For a long time under the sun.
- To resort to physiotherapy.
- Eat as usual.
The question of nutrition is most important for patients with stomach cancer. Since after the operation the body size is reduced or an anastomosis is created, it is necessary to adhere to certain rules in the choice of dishes.
The first two or three post-operative weeks a person should eat infant formula - adapted mixtures and puree. In the future, ordinary food is used, but it must be wiped, and the amount of food at one time should not exceed 300 grams.
Chemical irritants, in the form of sharp, smoked pickled dishes, too salty food, alcohol is excluded. To the usual diet gradually pass about a year later, but with the normal restoration of the digestive function. But an operated person should always know that he is banned and completely excluded from his diet.
During the rehabilitation period, periodic checkups are conducted periodically, allowing timely detection of relapse of the disease.
Reviews after surgery for stomach cancer
Marina:
The diagnosis of stomach cancer to my husband was exposed a year and a half ago. First there was a shock, because my husband is only 47 years old. But then immediately we immediately consulted several oncologists, all of them unanimously asserted that the operation was necessary. Operated almost immediately, removed the upper part of the stomach. Husband very hard survived the recovery period, lost weight, became irritable. But now everything is gradually returning to normal. Began to gradually eat the usual dishes, of course not greasy and not too salty. No pain, as there is no metastasis - was examined a month ago. While on disability, but hopes to get a working group. The doctor recommended to periodically receive courses of vitamins and drink iron, because the food is not digested as it should. I hope that the worst thing is left behind.
Olga:
My stomach was removed almost immediately after the cancer was detected. After the operation, we started eating for more than four months. It seemed everything comes back to normal, but another examination showed the presence of metastases in the lungs. Now my mother is on anti-inflammatory drugs, and every day becomes weaker. I scold myself that I did not insist on a full examination about three years ago, when there were problems with digestion.
Prognosis of survival rate and how many patients live?
Survival of patients with gastric cancer after surgery depends on the stage at which surgical removal was performed.
Significantly reduced life with the appearance of distant metastases, palliative surgery only a few facilitate the health of a person.
Video of laparoscopic operation with D2 lymphodissection in stomach cancer: