During the preoperative signing conversation, when patients or family members hear that a total gastrectomy may be required, the first reaction is often whether only a partial resection can be performed, because they think that leaving a little bit of the stomach will definitely provide a better quality of life after surgery than a total gastrectomy. However, is this really the case? First of all, for gastric cancer, the purpose of surgery is to completely remove all tissues where cancer cells may be present, including the stomach and the lymph nodes around the stomach. The extent of gastrectomy is determined by the location of the lesion and the early or late stage of the disease. Cancer is like a crab’s foot (cancer is from the Latin word for crab), it is not enough to remove the body of the crab without removing the foot. Therefore, during surgery, we should not only remove the visible lesion, but also remove the whole part of the normal stomach wall around the lesion, otherwise the cancer cells that cannot be seen by the naked eye will remain and lead to recurrence. Because, if we arbitrarily reduce the resection area to preserve part of the stomach wall, we will lose more than we gain and destroy the thoroughness of the surgery. Secondly, for proximal gastric cancer and cardia cancer, when most of the proximal stomach is resected and the distal stomach is directly anastomosed with esophagus, many patients may have gastroparesis and esophageal reflux due to the loss of cardia function and severed vagus nerve. Gastroparesis can usually be solved by conservative treatment, while esophageal reflux may be severe and persistent, manifesting as acid reflux, burning sensation behind the sternum and esophagitis, which may even seriously affect eating and quality of life in severe cases. Therefore, most experts now advocate total gastrectomy for proximal gastric cancer or cardia cancer rather than major proximal gastrectomy, unless the lesion is early. In progressive proximal gastric or cardia cancer, total gastrectomy can avoid severe esophageal reflux and increase the completeness of surgery. Of course, some surgeons now choose to remove the proximal part of the stomach and place a section of small intestine between the esophagus and the stomach to avoid reflux, but this method is not widely used and its effectiveness remains to be seen. The main function of the stomach is to store and stir food, and through the action of gastric acid and gastric enzymes, the food is turned into a porridge for digestion and absorption in the intestine. In fact, the digestion and absorption ability of stomach is very weak, and the digestion is mainly through bile, pancreatic juice and small intestine fluid, while the absorption of nutrients is mainly through small intestine. Therefore, the quality of life is not necessarily seriously affected after total gastrectomy. Of course, in the long run, vitamin B12 deficiency, anemia and malnutrition after total gastrectomy should still be taken care of.
Support Us
Discussion
Share your experience, or seek help from fellow patients.
