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Gastric cancer

The stomach is an organ located in the abdomen, between the esophagus and the small intestines. The stomach ensures that the food taken with nutrition is stored and disintegrated, making it ready for digestion. The foods that are broken down in the stomach pass into the duodenum, combine with the bile from the pancreatic gland and are digested through the small intestines. When gastric cancer is mentioned, a tumor originating from the inner surface of the stomach and located in the stomach wall comes to mind. Stomach cancer spreads through lymphatic vessels and lymph nodes. In addition, the growth of the mass into the surrounding tissues is another form of spread of the disease. The aim of the treatment of gastric cancer is to remove the part of the stomach containing the mass together with the surrounding lymph nodes.

HOW IS DIAGNOSED?
The aim of the treatment of stomach cancer is to remove the diseased organ from the body together with the lymph nodes that are likely to spread. This is possible with surgery. The blood supply of the stomach, which is the main stop organ for nutrition and digestion, is provided by 3 main vessels. These veins originate from the root of the vein called the celiac truncus, which originates from the main artery. Lymph nodes around the stomach are located next to these vessels. In addition, just below the liver, there are the portal vein (portal vein), the main hepatic artery, and the lymph nodes around the main artery and veins. During surgery, these vascular structures should be revealed carefully and without injury, and the tissues containing the lymph nodes should be removed carefully and preserving their integrity. It is a fact accepted by the scientific community all over the world that the chance of disease-free survival increases considerably with the quality of the surgery performed. For this reason, gastric cancer surgery requires very high surgical experience and skills. In gastric cancer surgery, the aim is not only to remove the diseased stomach, but also to clean the lymph nodes, which is important for the course of the disease.

Depending on the location of the tumor, the stomach is usually removed completely. This is also important for the collection of lymph nodes around the stomach. Rarely, if the tumor is located in the lower parts of the stomach, the upper parts of the stomach are preserved, leaving a reservoir stomach behind.

After the stomach is removed, the connection between the esophagus and the duodenum must be restored. For this reason, the small intestine is used and a new stomach is made and the operation is terminated.

In cancers originating from the junction of the stomach and esophagus (cardia region), the last part of the esophagus is removed to obtain a disease-free border, and in rare cases, it may be necessary to open the thorax to completely remove the mass of the esophagus.

If the mass has enlarged to the surrounding organs (for example, if it is attached to the liver or pancreas), partial removal from these organs may be required. The larger the surgical intervention, the greater the possibility of complications in the postoperative period.

Millimeter-sized tumor cell foci may be widely located in the abdomen. In some cases that cannot be detected by computed tomography, it can be detected during surgery. In this case, which is called carcinomatous peritoneal, the surgery is terminated.

SURGERY TECHNIQUE
The technique used in gastric cancer surgery is total radical gastrectomy with extended lymphadenectomy. With the classical surgical approach, the operation is performed by opening the abdomen. Today, these surgeries can be performed safely with laparoscopic technique and robot-assisted surgery.

PROBLEMS THAT MAY BE SEEN AFTER THE SURGERY
The most important problem that can be seen is the leaks that may develop in the suture line connecting the structures. Although the most important factor in these leaks is the surgical technique, the performance and nutritional status of the patient can also be effective on wound healing. Leakage may occur in the sutures between the esophagus and the small intestine. Since the esophagus also travels in the thorax, these leaks can occur in the thorax as well as into the abdomen. Life-threatening infections can be seen in both regions. Endoscopic intervention can be applied in some limited situations, but generally secondary or third surgeries may be required. With the success of the surgical technique, the incidence of this condition is less than 0.5%. Rarely, there may be bile leaks from the upper part of the duodenum, which is closed, usually there is no need for surgery and this leak closes on its own.

WHAT AWAITS YOU AFTER STOMACH SURGERY?
By removing the stomach and then making a new pathway through the small intestine, the patient can eat normally. But this will not be like the patient’s life before the disease. Although a new route is made from the small intestine, it cannot be matched to the stomach in terms of this capacity. With the acid secreted from the stomach, the digestion process of proteins begins. In the absence of stomach and acid, protein metabolism may also be impaired. It also secretes the hormones necessary for the absorption of vitamins and iron, as well as the digestive store of the stomach. In the absence of the stomach, these elements should be added to the daily diet externally. The amount of portion should be reduced and the number of meals should be increased. Attention should be paid to a diet rich in protein.

Gastric Cancer

The stomach is an organ located in the abdomen, between the esophagus and the small intestines. The stomach ensures that the food taken with nutrition is stored and disintegrated, making it ready for digestion. The food that is broken down in the stomach passes into the duodenum, combines with the bile from the pancreatic gland and is digested through the small intestines. When gastric cancer is mentioned, a tumor originating from the inner surface of the stomach and located in the stomach wall comes to mind. Stomach cancer spreads through lymphatic vessels and lymph nodes. In addition, the growth of the mass into the surrounding tissues is another form of spread of the disease. The aim of the treatment of gastric cancer is to remove the part of the stomach containing the mass together with the surrounding lymph nodes.

HOW IS DIAGNOSED?
The aim of the treatment of stomach cancer is to remove the diseased organ from the body together with the lymph nodes that are likely to spread. This is possible with surgery. The blood supply of the stomach, which is the main stop organ for nutrition and digestion, is provided by 3 main vessels. These veins originate from the root of the vein called the celiac truncus, which originates from the main artery. Lymph nodes around the stomach are located next to these vessels. In addition, just below the liver, there are the portal vein (portal vein), the main hepatic artery, and the lymph nodes around the main artery and veins. During surgery, these vascular structures should be revealed carefully and without injury, and the tissues containing the lymph nodes should be removed carefully and preserving their integrity. It is a fact accepted by the scientific community all over the world that the chance of disease-free survival increases considerably with the quality of the surgery performed. For this reason, gastric cancer surgery requires very high surgical experience and skills. In gastric cancer surgery, the aim is not only to remove the diseased stomach, but also to clean the lymph nodes, which is important for the course of the disease.

Depending on the location of the tumor, the stomach is usually removed completely. This is also important for the collection of lymph nodes around the stomach. Rarely, if the tumor is located in the lower parts of the stomach, the upper parts of the stomach are preserved, leaving a reservoir stomach behind.

After the stomach is removed, the connection between the esophagus and the duodenum must be restored. For this reason, the small intestine is used and a new stomach is made and the operation is terminated.

In cancers originating from the junction of the stomach and esophagus (cardia region), the last part of the esophagus is removed to obtain a disease-free border, and in rare cases, it may be necessary to open the thorax to completely remove the mass of the esophagus.

If the mass has enlarged to the surrounding organs (for example, if it is attached to the liver or pancreas), partial removal from these organs may be required. The larger the surgical intervention, the greater the possibility of complications in the postoperative period.

Millimeter-sized tumor cell foci may be widely located in the abdomen. In some cases that cannot be detected by computed tomography, it can be detected during surgery. In this case, which is called carcinomatous peritoneal, the surgery is terminated.

SURGERY TECHNIQUE
The technique used in gastric cancer surgery is total radical gastrectomy with extended lymphadenectomy. With the classical surgical approach, the operation is performed by opening the abdomen. Today, these surgeries can be performed safely with laparoscopic technique and robot-assisted surgery.

PROBLEMS THAT MAY BE SEEN AFTER THE SURGERY
The most important problems that can be seen are the surfaces that can develop in the interconnected seam line. Although the most important factor in these connections is surgical technique, memory performance and nutritional status may also have an impact on wound healing. It is seen in the seams between the esophagus and the thin outlet. Since the esophagus also travels in the thorax, these patterns allow the thoracic cage to enter as well as the abdomen. Both regions can be seen as threatening protection. Containment or third surgeries may usually be required, with the exception of some local enclosures that may be endoscopically intervened. With the success of the surgical technique, the incidence of this result is below 0.5%. Rarely, there may be biliary dissemination from the closed upper part of the duodenum, usually there is no need for surgery and all of these samples are gone.

WHAT AWAITS YOU AFTER STOMACH SURGERY?
By removing the stomach and then making a new pathway through the small intestine, the patient can eat normally. But this will not be like the patient’s life before the disease. Although a new route is made from the small intestine, it cannot be matched to the stomach in terms of this capacity. With the acid secreted from the stomach, the digestion process of proteins begins. In the absence of stomach and acid, protein metabolism may also be impaired. It also secretes the hormones necessary for the absorption of vitamins and iron, as well as the digestive storage of the stomach. In the absence of the stomach, these elements should be added to the daily diet externally. The amount of portion should be reduced and the number of meals should be increased. Attention should be paid to a diet rich in protein.