Stomach cancer surgery, typically a gastrectomy, involves removing part or all of the stomach to treat the disease. A partial gastrectomy removes only the affected section, while a total gastrectomy removes the entire organ. This major operation fundamentally alters digestion, requiring significant long-term adjustments. This guide outlines what to expect during recovery and the subsequent years, focusing on the practical changes necessary to maintain health.
Immediate Post-Operative Recovery
Immediate post-operative recovery involves intensive monitoring, often starting in a high-dependency or intensive care unit. Initial pain management utilizes patient-controlled analgesia (PCA) or epidural catheters for continuous relief. As the patient stabilizes, medication is gradually transitioned to oral tablets.
Various tubes and drains are used in the first few days. These include a nasogastric (NG) tube to drain fluid, surgical drains near the incision to prevent fluid buildup, and an indwelling catheter to monitor urine output. As the gut begins to function, these tubes are progressively removed. The surgical incision requires careful monitoring for signs of infection, and patients are taught how to keep the wound clean at home.
Early mobilization is integral to healing; nurses and physical therapists encourage walking as early as the day after the operation. Gentle walking helps prevent complications like blood clots and pneumonia, accelerating recovery. While the average hospital stay is 3 to 10 days, full physical recovery, including the return of energy and stamina, can take between 3 and 6 months or up to a year.
Long-Term Dietary and Digestive Adjustments
The removal of the stomach means the body loses its food reservoir and its ability to slowly release partially digested food into the small intestine. This anatomical change necessitates a permanent shift in eating habits to accommodate the smaller capacity and altered digestive flow. Patients must consume small, frequent meals, often six to eight times a day, instead of three large ones.
Thorough chewing is necessary because the small amount of stomach acid remaining, if any, and the lack of mechanical churning mean the food must be well-broken down before swallowing. To maximize the space for solid food, liquids should be avoided for 30 to 60 minutes before and after meals. This separation prevents the rapid flushing of food into the small bowel, which can trigger symptoms.
Dumping syndrome is a common post-surgical issue, occurring when food moves too quickly from the altered stomach pouch into the small intestine. Early dumping happens 15 to 30 minutes after eating, caused by hyperosmolar contents (often high in sugar) drawing fluid from the bloodstream into the intestine. This fluid shift can cause abdominal cramping, diarrhea, nausea, dizziness, or weakness.
Late dumping syndrome occurs one to three hours after a meal due to the rapid absorption of sugar into the bloodstream. This surge causes the pancreas to overproduce insulin, leading to hypoglycemia (a quick drop in blood sugar), which presents as weakness, sweating, and rapid heart rate. Prevention involves strictly limiting foods high in simple sugars, incorporating protein and fat into every small meal to slow digestion, and resting after eating.
Managing Potential Complications and Nutritional Needs
The lack of a stomach impairs micronutrient absorption, leading to lifelong deficiencies managed through supplementation. Gastrectomy commonly causes Vitamin B12 deficiency because the stomach lining produces intrinsic factor, a protein required for B12 absorption. Patients who have had a total gastrectomy require lifelong B12 injections, as the oral form is not effectively absorbed.
Iron deficiency anemia is a frequent consequence, caused by the reduced availability of gastric acid necessary to convert dietary iron into an absorbable form. Surgical rerouting often bypasses the duodenum, the primary site of iron absorption. Patients are monitored with regular blood tests to check iron and B12 levels, and many require oral iron supplements.
Calcium and Vitamin D deficiencies are a concern due to altered absorption, linking them to a higher risk of bone issues like osteoporosis. Lifelong, specialized multivitamin and mineral supplementation is necessary, often including fat-soluble vitamins (A, D, E, K). Initial weight loss is expected, and a dietitian will work closely with the patient to ensure adequate caloric and protein intake to maintain a healthy weight and muscle mass.
Follow-up Care and Resuming Normal Life
A structured follow-up schedule monitors for potential cancer recurrence and manages long-term side effects. Patients see their oncologist and surgeon every three to six months for the first few years, with frequency decreasing over time. These visits include physical examinations and blood tests to check nutritional markers, such as Vitamin B12, iron, and other micronutrient levels.
Imaging tests and endoscopy may be performed periodically to check for any signs of recurrence or complications like marginal ulceration. Although there is no universal standard for surveillance, the follow-up program is tailored to the individual’s specific cancer stage and surgical outcome.
The transition back to daily life involves gradually resuming physical activities. Heavy lifting (over 10 pounds) should be avoided for approximately eight weeks to allow incisions to heal fully. Gentle exercise, such as walking, is encouraged to rebuild strength and energy. Emotional support is important, as adjusting to this major life change can be challenging, and patients should discuss anxiety or depression with their healthcare team. Most people return to work and drive between four and eight weeks after surgery, depending on the nature of their job and the extent of their recovery.