If you are found suitable for the surgery, you will be usually admitted one or two days prior to the proposed date of surgery. There may be dietary restrictions and you may be given laxatives to evacuate your bowels prior to surgery. Your blood group will be checked and blood is usually reserved for all major abdominal surgeries.

It is always a good idea to start with deep breathing exercises once you are admitted to the hospital. Your doctor may summon a physiotherapist to assist you with the same. You will have most of your body parts shaved for the surgery. You will be given a consent form for your signature. The form would have details of the procedure to be performed on you by your treating surgeon. In case you have any doubts you should feel free to ask them to the surgical team

The position of the tumour in the stomach will determine how much of the stomach is removed.
If your cancer is at the lower end of the stomach (that connects with the duodenum) you may have only the lower part of your stomach removed. This is called a partial (distal) gastrectomy. After the operation you will have a much smaller stomach but the valve (cardiac sphincter) between your oesophagus (oesophagus) and stomach will still be there.

If your cancer is in the upper portion of the stomach or at an area where your stomach is joined to your oesophagus, the upper part of the stomach along with a portion of the lower end of the oesophagus is removed as well. This is called Oesophago-gastrectomy or Proximal Partial Gastrectomy. The top portion of your oesophagus will then be joined to your remaining stomach.

If your cancer is in the middle of the stomach you may need to have your whole stomach removed. This operation is called a total gastrectomy with a Roux-en-Y reconstruction. After the operation, your oesophagus is joined directly to your small intestine.

Often, the lymph nodes close to the stomach are removed at the same time to see if the cancer cells have spread into them. Taking them out reduces the risk of your cancer coming back in the future. Depending on the extent of the cancer, some other organs in the area of the stomach may be removed during the operation. These may include the lower part of the oesophagus, the upper part of the small bowel (duodenum), the spleen or part of the pancreas.

Sometimes the cancer may block the passage of food from the stomach to the bowel. If this happens, the surgeon may make a connection between the stomach and the small intestine to allow food to bypass the blockage. This is known as bypass surgery and will not cure the cancer, but can relieve symptoms.

You will be transferred to the Intensive care unit after the surgery. Your recovery will depend on the magnitude of surgery performed. After the operation, the patient is usually monitored in the ICU for 48 to 72 hrs and the overall hospital stay (if no complications) is usually between 10–14 days. Your pain and discomfort will be taken care of by the anaesthetic team. You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few days. You will also have a naso-gastric (NG) tube in place. This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours. Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag.

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.

After an anaesthetic, the movement of the bowel slows down and usually takes about 72 hours to get back to normal. After about 48-72 hours you will probably be ready to start taking small sips of water, however, your doctors will tell you when it is appropriate for you to start drinking some fluids. This will be gradually increased after a couple of days until you are able to eat a light diet, usually four or five days after your operation.

You will probably be ready to go home in about two weeks after your operation and once your stitches have been removed. If deemed appropriate your doctor may send you home with stitches and call you later to remove the stitches. By and large, you should be able to climb several flights of stairs after your discharge from the hospital and you will be given diet instructions.

Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic.

At first, even tiny meals may make you feel uncomfortably full. If you have had part of your stomach removed, it will not stretch as much as it did before. If you have had all your stomach taken away, the small bowel will need to stretch to take larger amounts of food. You will need to eat very small amounts very often at first. Then, gradually increase the amounts and then the time between meals. At first, you may find you need to eat every hour or so in order to get enough nutrition.

There is no restriction on the type of food you eat after a stomach surgery and you should be able to eat all that you did before surgery. Fizzy drinks can make you feel full – it is probably best not to drink with meals at all, as any liquid will fill you up.

Try keeping a food diary if you are having problems you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and when on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.

Stomach is an important organ for absorption of iron, calcium and vitamin D. If you have had a stomach surgery, you may not be able to get enough iron, calcium and vitamin D. Try and include food that contains these nutrients in your diet

Calcium is found in milk, cheese and bread. It is also found in eggs, cabbage and broccoli. Vitamin D is added to margarine. It is also found in butter, eggs and oily fish. Many foods contain iron including red meat, liver, fish, soya, wholemeal bread, egg yolk, leafy green vegetables, dried fruit etc.

If you are a vegetarian, you will probably need to take iron tablets. Vitamin C helps you absorb iron from food. So eat an orange, drink fresh orange juice or take vitamin C tablets with iron-rich foods or iron tablets.

Dark green, leafy vegetables and liver also contain folic acid. Folic acid is another vitamin needed to keep your red blood cells healthy. You may need extra folic acid if you have had stomach surgery.

Even if you eat a really healthy diet, you may still need to take supplements. This is because you do not have enough stomach tissue left to be able to absorb particular nutrients properly. Your doctor may suggest multi-vitamin tablets for you to be taken for a long time especially so if you are losing weight after stomach surgery.

Your doctor may be able to give you a rough idea of the disease stage on basis of the scans and tests. However, if a surgery has been performed then the pathology report (the main biopsy report) will be the best guide to determine the stage of cancer. Your doctor will be able to give you more accurate information only after the pathology report. This will also decide if there is a need for further treatment after the surgery.

Once you have been diagnosed with cancer and if a surgery is recommended to you, you should try and go ahead with the surgery at the earliest. This does not mean that if the surgery is not performed in a day or two, things will worsen. Only in cases where tumor is causing major symptoms for eg intestine block or jaundice or bleeding, surgery becomes imperative at the earliest.

Treatments after surgery will depend on the final pathology report. Your treating doctor may suggest chemotherapy or radiation therapy. It is not necessary for all tumors to be treated with both these modalities. In early stage of cancers surgery may be potentially curable and you may not need any chemotherapy or radiation treatment. In case if some treatment is suggested to you after surgery, the treatment by and large starts after 3 weeks till your wounds have healed completely and you have regained your strength.

People who have been treated for cancer need regular check-ups. This allows your doctors to keep an eye on your health. It may also help you to feel more confident about your health after treatment. You should see your treating doctor once every 3 months for the first two years. You will be advised some blood tests and scans (ultrasound or CT scan or PET scan) during your visit as felt necessary by the doctor.