What should patients do before gastric cancer surgery?

• The physician will also typically perform a more comprehensive examination, including blood tests, electrocardiogram, and cardiopulmonary function tests, with the goal of assessing whether the patient can tolerate the procedure.

Adjustment of physical condition and medication

• Patients who have a smoking habit need to stop smoking at least 2 weeks in advance, and they are usually instructed to perform deep chest breathing exercises and sputum evacuation exercises. In elderly patients in particular, these methods can help prevent postoperative lung infections.
• For patients with high blood pressure and high blood glucose, the physician will usually adjust the relevant indexes to the appropriate range before surgery.
• Patients who have been taking antiplatelet and anticoagulant medications such as Aspirin, Clopidogrel, and Warfarin for a long time for other medical conditions are usually asked to stop taking them for at least 1 week before surgery, otherwise there is an increased risk of intraoperative bleeding.
• Patients with infectious fever and menstrual periods are usually delayed because of the increased risk of intraoperative bleeding and postoperative infection.

Some patients and their families may be concerned that the above management sometimes makes the surgery delayed by a few days and may cause the spread of gastric cancer cells. In fact, gastric cancer often develops over a long period of time (measured in months or years), and delaying surgery for a few days does not spread or make the disease more severe when it was already confined.

Psychological Conditioning

Surgery and tumor may cause dual psychological stress to patients. Patients are often filled with fear and anxiety before surgery, resulting in sleep disturbances, decreased appetite, and weak resistance, all of which are detrimental to postoperative recovery. Family members should promptly detect fluctuations in the patient’s mood, encourage the patient to express their feelings and learn to relax themselves, and provide psychological guidance according to the patient’s individual situation to enhance the patient’s confidence in surgical treatment.

Take care of diet and nutrition

• Patients with gastric cancer mostly suffer from constipation, loss of appetite, blood in stool, vomiting, etc. Together with tumor depletion, they often suffer from malnutrition or anemia, so their diet should be high in protein, high in calories, high in vitamins, low in fat, easy to digest and less dregs.
• For those who cannot eat, physicians usually actively improve the patient’s nutritional status before surgery and increase their tolerance for surgery through intravenous infusion of nutrients, supplementation of vitamins, electrolytes and micronutrients.
• For gastric cancer patients with severe anemia, malnutrition and hypoproteinemia, doctors usually infuse concentrated red blood cells or supplemental albumin in small amounts and fractions to achieve a hemoglobin of 100 g/L and a total plasma protein of 60 g/L or more, if possible.
• Adults must fast 12 hours before surgery and abstain from water 4 hours before surgery. During the preoperative fast, the surgeon will usually administer intravenous fluids and parenteral nutrition support as needed to maintain adequate fluid volume and calories.

Understand the risks of surgery and sign an informed consent form

The surgeon will have a preoperative conversation with the patient and family about the basic condition of the patient and tumor, the choice of surgical options, what the risks of surgery may be, what complications may occur after surgery, and how far they can recover. After understanding the above surgery-related circumstances and agreeing to the surgery, the patient and family members must sign the relevant consent form.

Anesthesia evaluation

Since gastric cancer surgery requires general anesthesia, the anesthesiologist usually visits the patient before surgery to ask questions and to fully assess the function of the vital organs based on laboratory and test results to determine whether the patient can tolerate general anesthesia.

Other

• If there is pyloric obstruction, the patient is placed into a gastric tube several days before the procedure and the stomach is repeatedly flushed through the tube so that the procedure is not interrupted by the accumulation of large amounts of food in the stomach.
• Because patients typically spend 24 hours in bed after surgery, they can begin bedside bowel and urinary practice 2 to 3 days before surgery.
• One day before surgery, the nurse removes hair from the surgical area, including the perineal area, and cleans it, called “skin preparation.
• The nurse also usually performs a preoperative drug sensitivity test to select the appropriate antibiotic for use during and after the procedure.
• Patients are also tested for blood type, etc., so that the doctor can request matching blood products to be used as needed during the procedure.

The patient does not need to worry too much about the above seemingly complex preparations, and the medical staff will assist with many of them. As a patient, the most important thing is to cooperate in the preoperative preparation and to have confidence in yourself, in the surgery, and in overcoming the disease. (Contributed by Jun Yan Zhang, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)