Upper Gastrointestinal Surgery

Laparoscopic gastric cancer surgery Is laparoscopic (key-hole) surgery possible in all cases of gastric cancer?

Gastrectomy for gastric cancer via an open abdominal approach has been performed since the 1920s. Laparoscopic gastrectomy was ﬁrst described in Japan in 1994 and the procedure is safe, feasible, and oncologically sound when performed by experienced surgeons. Patient related factors such as medical conditions and cancer stage may inﬂuence the choice of open versus laparoscopic surgery. Patients with severe heart / lung disease may not tolerate prolonged pneumoperitoneum (carbon dioxide (CO2) gas is insuﬄated into the abdominal cavity during laparoscopy surgery), open surgery is likely safer for this group of patients.

Patients with gastric cancer that has not invaded surrounding organs and without bulky lymph nodes are suitable candidates for laparoscopic procedures. Additionally, laparoscopic surgery is also an option for patients with locally advanced cancer that has downstaged following chemotherapy.

What are the possible complications of the operation?

The list of complications included is not meant to be exhaustive. Any complications may possibly lead to prolonged hospital stay, long-term disability and even death. Other than potential risks associated with anaesthesia, the complications of gastrectomy include –

wound infection / infection inside abdominal cavit
leaking from a join made during surgery
narrowing from a join made during surgery causing intestinal blockage
internal bleeding
internal / external hernia
impaired gastric emptying
dumping syndrome – a condition where food moves too quickly from the stomach to the small intestine, causing symptoms like nausea, cramping, and dizziness after eating
nutrition deﬁciency

How much stomach will be removed?

The amount of stomach that needs to be removed during a gastrectomy depends on the location and extent of the disease (eg: tumour location), as well as the type of surgery being performed.

Here are some common types of gastrectomies and their corresponding indications:

Total Gastrectomy: Removal of the entire stomach. This is often performed for:
- Cancer that has spread throughout the stomach
- Cancer at the upper part of the stomach
Distal Gastrectomy: Removal of the lower half of the stomach (about 60-70%). This is often performed for:
- Cancer in the lower part of the stomach
Proximal Gastrectomy: Removal of the upper part of the stomach. This is often performed for:
- Early Cancer in the upper part of the stomach

How long is the recovery?

While the time to discharge from hospital after laparoscopic surgery is normally within 7 -10 days, recovery and time to healing diﬀers between individuals. Post-surgery pain is normally tolerable, and controlled with medicine. Mobility is normally achievable on the day after surgery, while the health care team watches for bleeding, infection or other complications

Will I be able to eat and have a normal digestion after the operation?

After a gastrectomy, you can still consume food normally, but you will need to make some adjustments to your eating habits. Here are some guidelines to help you adapt:

Eat smaller, frequent meals more often
Choose foods that are easy to eat (avoid raw / tough / chewy food)
Limit the amount of liquids you have with meals
Eat protein with each meal
By making these adjustments, you can continue to enjoy a varied and satisfying diet while
supporting your recovery and long-term health.

Laparoscopic resection of GIST (Gastrointestinal stromal tumours) Is laparoscopic (key-hole) surgery possible in all cases of GIST?

Laparoscopic surgery is the choice for GIST resec ons whenever possible as it gives a faster recovery. In larger GIST tumours, we would recommend a course of pre-surgery treatment to shrink the tum

In cases where pre-surgery treatment is not possible or where the tumour remains large, open surgery is still necessary.

How much stomach is removed during the operation?

In most cases, a wedge resection of the stomach is all that is required. This involves taking just a small section of the stomach together with the GIST. However, if the GIST is located close to the entrance or exit of the stomach, surgical removal might need to involve these critical areas too. What ensues will be a reconstruction of the entrance or exit of the stomach to re-establish continuity of the digestive tract.