Gastrectomy is the total or partial surgical excision of the stomach. In total gastrectomy, the surrounding tissues, lymph nodes, and frequently the spleen are also removed. Some side effects and long term effects mentioned in the gastroenterology texts are the following: pneumonia, anastomotic leak, hemorrhage, small-bowel obstruction, severe vitamin B12 defficiency, folate and thiamin defficiency (the latter called Wernicke-Korsakoff syndrome), pain, chronic diarrhea, nausea, discomfort after meals, the dumping syndrome (a great deal of distress after meals, including severe diarrhea, related to the fact that undigested meals get dumped into the small intestine), and alkaline reflux gastritis. A higher incidence of heart attacks has also been reported.
One recent source notes that "the risks of fatal hemorrhage and perforation [during chemotherapy] have probably been vastly overestimated and appear to be equal or less than the mortality associated with surgery. In addition, the long-term effects of gastrectomy on quality of life have been almost completely ignored." While many experts are speaking against the routine use of gastrectomies for gastric lymphomas, there are still many who do recommend them.
It has been shocking for me to read about routine stomach removals for a type of lymphoma which has such a slow and relatively benign course. For example, one study mentioned an 80 year old woman with MALT lymphoma who underwent gastrectomy with radiation, as well as chemo when her cancer recurred less than a year later. She died 6 years later from the damage the radiation caused to her intestines. One has the feeling that the treatment not only made her last years utterly miserable, but also hastened her death. The study in question considers her a success because she was found lymphoma-free upon autopsy, and expresses no concern over the choice of treatment in her case.
Even in higher grade MALT lymphomas, some recent sources no longer recommend gastrectomies, which they feel is not a reasonable approach. In a retrospective analysis of 56 patients with GI lymphomas, the patients who had partial gastrectomy and chemo vs those who had chemo without surgery, there was no advantage shown for those with surgery.
In view of the small amount of attention paid traditionally by proponents of gastrectomies to the experience of patients, and the impact of these operations on their quality of life, all patients are well advised to seek referrals to other lymphoma patients who underwent it, and inquire after their experience with it, if their doctor recommends this operation. If the doctor is unable to refer them to other patients, the lymphoma patient organizations may be able to facilitate such a connection. And if you decide to go ahead, then make very sure that you are instructed in detail on proper dietary guidelines, as well as the side effects to watch for, how to prevent them, and how to best deal with them if they do occur.
Some useful links:
www.gicare.com/pated/edtgs09.htm
Search Oncolink for gastrectomy articles. Their links change over time, but they always have useful stuff around. oncolink.com
Gathered by Vera Bradova © 1999-2003
Updated 7-31-2003
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