Treatment of Total Gastrectomy

Total gastrectomy is a complex surgical procedure that involves the complete removal of the stomach. It is typically recommended for patients diagnosed with certain types of stomach cancer, severe ulcers, or other malignant or non-malignant conditions that affect the entire stomach.

However, in certain severe medical conditions such as advanced stomach cancer, hereditary stomach disorders, or large gastrointestinal tumors, the entire stomach may need to be surgically removed a procedure known as total gastrectomy. While this surgery sounds extreme, it can be a life-saving intervention that significantly improves a patient’s prognosis and quality of life when performed at the right time and under expert care.

What Is Total Gastrectomy?

Total gastrectomy is a surgical operation that removes the entire stomach and connects the esophagus directly to the small intestine. It is often used in cases where cancer has spread throughout the stomach, making partial removal insufficient. In some cases, it may also be done for genetic conditions like hereditary diffuse gastric cancer (HDGC) to prevent cancer development.

Since the stomach plays a crucial role in digestion and food storage, its removal requires significant adjustments to how the body processes food.

Conditions That Require Total Gastrectomy

Total gastrectomy is usually indicated for :-

1. Stomach Cancer :- Particularly when the cancer affects most or all of the stomach lining.

2. Gastrointestinal Stromal Tumors (GISTs) :- Large or multiple tumors that are not amenable to partial gastrectomy.

3. Hereditary Diffuse Gastric Cancer (HDGC) :- For people with a high genetic risk, prophylactic gastrectomy is sometimes recommended.

4. Chronic Gastric Ulcers :- Rarely, when complications like perforation or severe bleeding occur and other treatments fail.

Preparing for the Surgery

Before undergoing total gastrectomy, patients must go through a comprehensive preoperative evaluation. This includes diagnostic imaging (CT scans, endoscopy, or PET scans), blood tests, nutritional assessment, and consultation with both a surgical oncologist and anesthesiologist.

Doctors will often recommend :-

1. Stopping certain medications such as blood thinners.

2. Following a special diet a few days before surgery.

3. Beginning nutritional support or supplements if the patient is malnourished.

Informed consent and psychological counseling are also important, especially when the surgery is elective and preventive, as with genetic cancer risk.

Treatment of Total Gastrectomy

The surgery can be done in two main ways:

1. Open Total Gastrectomy :- This involves a large incision in the abdomen to access and remove the stomach. It allows for direct visualization and easier removal of affected lymph nodes.

2. Minimally Invasive or Laparoscopic Total Gastrectomy :- This uses smaller incisions with the help of a camera and specialized instruments. It results in less postoperative pain and quicker recovery, but not all patients are candidates.

   During the surgery, the surgeon will :-

   • Remove the stomach completely.

   • Remove nearby lymph nodes to check for the spread of cancer.

   • Reconstruct the digestive tract by connecting the esophagus to the jejunum (a part of the small intestine), creating an esophagojejunostomy.

   The procedure can take 4 to 6 hours depending on the complexity.

3. Postoperative Recovery :- Hospital recovery after a total gastrectomy typically lasts 7 to 10 days. Immediately after surgery, patients are monitored in a recovery unit or ICU. They may receive :-

   • IV fluids and nutrition :- To keep hydrated and nourished before oral intake is possible.

   • Pain management :- Usually through epidurals or IV medications.

   • Nasogastric tube :- To remove secretions from the digestive tract.

   • Antibiotics and blood clot prevention :- To reduce complications.

   Oral feeding starts gradually, beginning with sips of water and clear liquids, followed by a soft diet. Nutritional support from a dietitian is critical.

Life After Total Gastrectomy

Adjusting to life without a stomach can be challenging, but with proper medical and nutritional guidance, most patients can return to a good quality of life. Here’s what patients need to consider :-

1. Nutritional Adjustments :- Without a stomach, food passes more quickly into the small intestine, leading to a condition called dumping syndrome. This can cause nausea, cramps, and diarrhea. To manage this, patients should :-

   • Eat small, frequent meals.

   • Avoid sugary and high fat foods.

   • Chew food thoroughly.

   • Sit upright while eating and remain seated for 20–30 minutes after meals.

   Patients may also need lifelong vitamin B12 injections since the stomach is responsible for intrinsic factor, necessary for B12 absorption. Iron, calcium, and vitamin D supplementation may also be required.

2. Weight Loss and Digestion :- Most patients experience rapid weight loss after the procedure. A nutritionist will help create a diet plan that ensures enough calories, protein, and essential nutrients are consumed.

   Digestive enzymes or medications may be prescribed to support digestion.

Possible Complications

Like any major surgery, total gastrectomy carries some risks. These include :-

1. Infection at the surgical site.

2. Anastomotic leak, where the connection between esophagus and small intestine may leak.

3. Bleeding during or after surgery.

4. Nutritional deficiencies over time.

5. Bowel obstruction or delayed gastric emptying.

Long term follow up is essential to detect and manage any complications early.

Emotional and Psychological Support

Adapting to life after the removal of an organ as central as the stomach can be emotionally difficult. Patients may struggle with anxiety, changes in body image, or depression, particularly in the early recovery stages. Support groups, psychological counseling, and patient education can provide relief and encouragement.

Family support and regular consultations with the medical team are vital during this transition period.

Outlook After Total Gastrectomy

Prognosis depends on the underlying reason for surgery. In cancer patients, outcomes are influenced by cancer stage, lymph node involvement, and overall health. For those undergoing prophylactic surgery due to genetic risk, the outlook is generally excellent with minimal recurrence risk.

With time, the body adapts remarkably well. Most patients can resume daily activities within a few months, although dietary and lifestyle changes become permanent. Advances in surgical techniques and postoperative care have significantly improved both survival rates and quality of life.

Conclusion

Total gastrectomy is a life saving treatment for many patients with advanced stomach conditions, especially cancer. While the procedure is major and recovery can be challenging, most patients go on to live healthy and fulfilling lives with proper care and support. Working closely with a multidisciplinary team that includes surgeons, oncologists, nutritionists, and psychologists can make a significant difference in both physical recovery and emotional well being.