Postoperative Complications of Gastrectomy for Stomach Cancer

Stomach (or gastric) cancer is a challenging disease and if you need to undergo a gastrectomy, it can be both physically and mentally demanding as it is a major operation. Post-surgery, you will go through a recovery process that can take some time with complications along the way. These complications can cause stress and anxiety for you and your loved ones. However, with proper preparation, you can have a better understanding of what you expect during the recovery period and what you can do to ensure a smoother healing process.

Often performed as part of gastric cancer treatment, a gastrectomy is a surgical procedure where all or part of the stomach is removed. Depending on the location of the cancer in your stomach and how far it has spread, your doctors will decide whether you need a partial or total gastrectomy to treat your type of gastric cancer..

The removal of your stomach is a major surgical procedure that can take anywhere from a few months to a year to fully recover. The recovery process can be long and difficult, and may not always be smooth sailing. As with any type of surgery, you may experience various problems during your hospital stay or after you return home. Some of the complications and side effects of a gastrectomy include:

Difficulty eating and weight loss

In the few days immediately after your surgery, you may need to avoid consuming food or drink so that the incisions (cuts) in your stomach or digestive tract are able to heal properly. Even after they have healed, you may have difficulty eating regular-sized meals and feel full a lot quicker because your stomach is so much smaller.

You may also experience problems swallowing, nausea or vomiting due to the occurrence of strictures, the narrowing of the gastrointestinal tract. For example, after a partial gastrectomy, leakage of stomach acid up into the esophagus after gastrectomy can lead to scarring and narrowing of the esophagus.

Regardless of the type of gastrectomy you’ve had, strictures can make it difficult to swallow food and you may find yourself losing weight quickly. To avoid excessive weight loss, it is best to follow the guidelines provided by your cancer care team. They will offer relevant tips on how to manage your diet and eating habits to ensure a healthy recovery. By relying on their advice and taking necessary precautions, you can avoid any potential risks.

Dumping syndrome

Under normal conditions, the stomach stores food and releases it into the small intestine in a controlled manner. However, after a gastrectomy, you may experience a condition known as dumping syndrome, which occurs when swallowed food empties into the small intestine too quickly. Dumping syndrome can result in a wide range of symptoms that occur from as little as 30 minutes to as much as four hours after eating a meal. These symptoms include abdominal cramps, nausea, diarrhea, heart palpitations and lightheadedness. You may also suffer from indigestion or heartburn. In order to mitigate these issues, you can consider eating at a slower pace or having smaller quantities of food at a time.

Poor absorption of nutrients

The stomach plays a vital role in your nutrition as it helps to absorb much-needed nutrients from your food so that you stay healthy and survive. After a gastrectomy, your body may not have the ability to absorb these nutrients as well as it could before. As a result, you may not be getting enough vitamins and minerals, which can hinder your recovery and lead to the development of more serious conditions.

One of the essential nutrients that your body may have difficulty absorbing is vitamin B12. Under normal circumstances, your stomach produces a protein called intrinsic factor, which binds to vitamin B12 and assists with its absorption in the small intestine. Since your stomach is removed during surgery, the absence of the intrinsic factor protein results in poor absorption of vitamin B12. Vitamin B12 is critical in keeping your red blood cells and nerve cells functional and healthy. It also aids in the production of DNA, the genetic material in all of your cells. If left to persist, a vitamin B12 deficiency can lead to anemia and side effects affecting your nervous system (such as numbness and tingling).

Undergoing a gastrectomy can also lead to malabsorption of iron from your diet, causing you to develop iron deficiency anemia. This is because removing your stomach results in significantly less gastric acid being produced, which is needed to convert dietary iron into a form that is more readily absorbed in the small intestine.

Apart from vitamin B12 and iron, you may suffer from poor absorption of vitamin D and calcium, both of which are needed for the formation of healthy bones. As such, a gastrectomy can increase your risk of bone density loss. If unaddressed, this can lead to osteoporosis, a medical condition that causes your bones to become weak, brittle and prone to fracture.

All of the above highlight the importance of monitoring the levels of these important vitamins and nutrients in the blood, and supplementing as needed.

Infections

There are two surgical approaches to a gastrectomy: open surgery and laparoscopic (or keyhole) surgery. The former involves a large incision being made from the breastbone down to below the belly button, while the latter involves several small incisions made in the abdomen. If these surgical wounds are not cared for properly after the operation, they can become infected due to bacteria or viruses entering the wound. This can lead to significant pain and discomfort. More seriously, the infection may spread into deeper tissues beneath the skin. Fever, chills or swelling and bleeding from the surgical site are some symptoms to look out for.

Having an abdominal wound also increases your risk of developing pneumonia. This can be fairly common after a gastrectomy, and can lead to breathing difficulties and a delayed recovery.

The healing process from a gastrectomy can be both lengthy and arduous. You may face setbacks along the way that can make you feel discouraged, but there are certainly ways to manage and cope with these complications. You should never hesitate to reach out to your support system and your cancer care team for their advice and resources. Their guidance and support can be invaluable in helping you navigate this recovery journey.