Beyond the Incision: Managing Recovery and Potential Side Effects of Stomach Can

1. Beyond the Incision: Managing Recovery and Potential Side Effects of Stomach Cancer Surgery in Singapore Stomach cancer surgery, or gastrectomy, is a major operation that fundamentally changes how the body digests food. In Singapore, as elsewhere, the recovery process extends far beyond the hospital stay, requiring significant lifestyle adjustments to ensure long-term health and quality of life. Understanding the common side effects and having a structured management plan is critical for a smooth transition back to daily life. The Immediate Post-Operative Period Most patients in Singapore spend approximately 5 to 7 days in the hospital. The initial focus is on pain management, preventing infection, and gradually reintroducing food and fluids. • Wound Care: Nurses will provide instructions on keeping the surgical site clean and dry. For open surgery, the incision is large, requiring careful management; minimally invasive (laparoscopic) procedures have smaller wounds and often a quicker initial recovery. Patients are typically advised to avoid heavy lifting for several weeks to prevent hernias. Mobility: Early mobilisation is key. Patients are encouraged to get out of bed and walk short distances soon after surgery to boost circulation and reduce the risk of complications like blood clots or pneumonia. Pain Management: A combination of patient-controlled analgesia (PCA) and oral medication is used to ensure comfort. It is important for patients to communicate their pain levels honestly to the care team. • • Navigating the New Normal: Dietary Adjustments The most significant and permanent change after a gastrectomy is the way food is consumed and digested. The body must adapt to the partial or total removal of the stomach, often leading to a loss of appetite and early satiety (feeling full after only a few bites). 1. The 'Small and Frequent' Rule • Portion Control: Instead of three large meals, patients must consume five to eight small meals or snacks throughout the day. This prevents the remaining digestive tract from being overwhelmed. Eating Routine: Since the normal "hunger" signals may be diminished or absent, patients are often advised to eat on a set schedule, using alarms if necessary, rather than waiting for hunger cues. Chewing and Hydration: Food must be chewed thoroughly, almost to a purée consistency, to aid digestion. Critically, fluids should be separated from solid food by about 30 minutes before and after meals to prevent feeling bloated and allow adequate room for nutritional food. • •

2. 2. Managing Dumping Syndrome Dumping Syndrome is a common side effect where food, especially sugary, high-carbohydrate food, moves too quickly from the pouch (or esophagus) into the small intestine. This rapid transit causes the body to release a surge of hormones. • Symptoms: This can manifest as Early Dumping (10-30 minutes after eating) with symptoms like cramps, diarrhoea, sweating, palpitations, and dizziness, or Late Dumping (1-3 hours after eating) which presents as weakness, confusion, and low blood sugar (hypoglycemia). Dietary Prevention: The primary management tool is diet. Patients should strictly limit simple sugars, sweets, sugary drinks, and concentrated carbohydrates. Focusing on high-protein, high- fibre, and complex carbohydrates helps slow down the digestive process. • Long-Term Nutritional & Health Considerations Beyond basic digestion, the missing stomach function leads to specific lifelong nutritional needs: • Vitamin B12 Deficiency: The part of the stomach lining that produces intrinsic factor, essential for absorbing Vitamin B12, is removed. This necessitates lifelong Vitamin B12 injections (usually monthly or quarterly) in a total gastrectomy. Iron and Calcium: Reduced acid secretion can impair the absorption of iron and calcium. Regular blood tests and oral supplements, guided by a dietitian, are essential to prevent anaemia and bone issues. Weight Management: Rapid weight loss is common. The focus for a post-gastrectomy patient shifts from weight loss to preventing muscle mass depletion and achieving a stable, healthy weight through nutrient-dense foods. • • Patients in Singapore benefit from a multidisciplinary care system, including surgeons, oncologists, dietitians (crucial for customising local food choices), and physiotherapists, all working together to help them adapt to their new body and ultimately improve their long-term quality of life. Full recovery and adaptation to the "new normal" can take anywhere from six months to over a year.