Survivorship: Health Concerns After Gastrectomy
Removal of all (gastrectomy) or part of the stomach (partial gastrectomy) leads to changes in the absorption of nutrients and digestion. Survivors should be followed by a dietitian who can help with GI symptoms and food choices. When the stomach is removed, the esophagus is connected directly to the small bowel, changing the way food is digested. This will require the person to eat smaller meals more often. These meals should have more proteins and fewer sugars and carbohydrates. This will help prevent issues such as nausea, vomiting, and diarrhea.
Absorption of Nutrients
Vitamin B12 is absorbed by the stomach. You will be given injections of B12 once or twice a month for life. Survivors may need calcium, folate, and iron. Survivors are at a greater risk for osteoporosis because of the poor calcium absorption. You should also not smoke, not drink excessive alcohol, and do weight-bearing exercises.
Dumping syndrome, which is nausea and abdominal cramping followed by diarrhea shortly after a meal, can also happen. This can be managed with changes to your diet like:
- Eating small, frequent meals that are high in protein and low in carbohydrates.
- Not drinking too much while eating food, so as to not flush out the food before nutrients are absorbed.
- You may find the information on the diet after esophagus surgery helpful.
After treatment, you can also have heartburn or reflux. It may be helpful to stay in an upright sitting position for at least one hour after meals to stop reflux from happening. Medications may also be helpful in reducing reflux and maintaining esophageal health. Given the changes from gastrectomy and other cancer treatment, survivors often have a hard time staying their weight and getting proper nutrition. A dietitian can help with making dietary changes, which can sometimes become less restrictive over time.
In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.
- Complications regarding inadequate nutrition can result after gastrectomy, in particular, Vitamin B12 deficiency. Make sure to work with dietitian and healthcare provider to ensure proper nutrition and to help manage problems resulting from surgery.
- Medications and behavioral adjustments may help with symptoms of dumping syndrome and reflux.
- Talk to your provider about calcium needs and osteoporosis prevention.
Cleveland Clinic. Post-Gastrectomy Syndrome Symptoms. Found at: https://my.clevelandclinic.org/health/diseases/17377-post-gastrectomy-syndrome
Karanicolas, P. J., Graham, D., Gönen, M., Strong, V. E., Brennan, M. F., & Coit, D. G. (2013). Quality of Life After Gastrectomy for Adenocarcinoma: A Prospective Cohort Study. Annals of Surgery, 257(6), 1039–1046.
Mangano, A., Rausei, S., Lianos, G. D., & Dionigi, G. (2015). Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Annals of surgery, 262(6), e110.