Having your operation for stomach cancer

This section is about what needs to happen before you have your operation. You can find information on

• Tests to find out how fit you are for surgery
• Pre assessment clinic
• Learning breathing and leg exercises
• At the hospital

Tests to find out how fit you are for surgery

You may have had some of these tests while your cancer was being diagnosed. If so, you may not need to have them done again. You may have

• Blood tests to check your general health and how well your kidneys are working
• A chest X-ray to check your lungs are healthy
• An ECG to check your heart is healthy
• Breathing tests (called lung function tests)
• An ECG while you are exercising

These tests are to make sure you are fit enough for your anaesthetic and to make a good recovery from your surgery.

Pre assessment clinic

About 1 to 2 weeks before your surgery you will have an appointment at the hospital pre assessment clinic. This prepares you for your operation and makes sure you are in the best possible health before surgery. You are likely to meet several members of your multi disciplinary team, including a surgeon, nurse, dietician and physiotherapist.

A member of the surgical team will give you information about your surgery, the benefits and possible risks, and what to expect afterwards. You may also meet the anaesthetist who will make sure you are fit enough for the surgery. You may sign the consent form to agree to the operation during this appointment.

The nurse will check your general health, weigh you, and take your blood pressure, pulse and temperature. They may take blood tests and arrange any other tests if needed. They will assess what help you may need after surgery once you are well enough to go home. They can also help answer any questions you may have.

The physiotherapist will assess how well you can move around and let the doctors know if there are any issues that may affect your recovery after surgery. They will also teach you leg and breathing exercises to do after your operation to help with recovery.

The dietician will give you help and advice about managing your diet before and after your surgery. They can give useful tips on how to increase the nutrients and calories in snacks, meals and drinks. You may need a feeding tube into your small bowel (jejunostomy) before or after surgery to make sure you get the nutrition you need. The dietician will give information and support with this.

Do ask as many questions as you need to during this appointment. It may be a good idea to write down all your questions to take with you. There are some suggestions for questions at the end of this section. The more you know about what is going to happen, the less frightening it will seem. Don’t worry if you think of more questions later. Just speak to your clinical nurse specialist or the nurses on the ward. They can answer your questions or ask the doctor to talk to you again.

Learning breathing and leg exercises

You can help yourself to get better by doing these exercises after your operation. Your physiotherapist or nurse will teach you the exercises. You should do them as often as you are told you need to.

Breathing exercises will help to stop you getting a chest infection. If you smoke, it really will help if you can stop at least a few weeks before your operation. You will be less likely to get a chest infection afterwards if you do stop.

Leg exercises help to stop clots forming in your legs. You may also have drugs to stop the blood from clotting so easily. You usually have them as small injections of heparin, tinzaparin, or dalteparin just under the skin. These usually start just before the surgery and continue for about 4 weeks afterwards. Your nurse may also give you compression stockings to wear.

Both chest infections and blood clots can happen if you are not moving around as much as you would normally. Your nurses will encourage you to get up and about as soon as possible after your operation. 

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.

View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

At the hospital

You may go into hospital on the morning of the surgery or the day before. If you have any further questions the nurses can arrange for a member of the surgical team to come and talk to you again. You will sign the consent form for the operation if you didn’t do it at the pre assessment clinic.

If you find eating and drinking difficult, you may have a drip (intravenous infusion) put into your arm before your surgery to give you fluids. This makes sure you are not dehydrated before your operation. Lastly, if you have body hair on your abdomen, you may need it shaved before your operation. This may reduce the risk of a wound infection after surgery. You may be shaved in the operating theatre after you are under the anaesthetic.

There is information here about

• Waking up in intensive care
• Tubes you might have (drips and drains)
• Painkillers
• Eating and drinking
• Your wound
• Getting up and about
• Making progress

Waking up in intensive care

If you've had a big operation you may wake up in intensive care (ICU) or a high dependency recovery unit. This is routine after a big operation and as soon as your doctors are sure you are recovering well, you will be moved back to the ward. This is usually within a day or so. In ICU you have one to one nursing care, and are checked very regularly. Again, this is normal and doesn't mean there is something wrong. Your surgeon and anaesthetist will keep a close eye on your progress. ICUs are very busy places and can be noisy. You'll be feeling drowsy because of the anaesthetic and painkillers. Some people find the experience of being in ICU a bit strange and disorientating.

Tubes you might have (drips and drains)

When you wake up, you will have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You will have

• Drips (intravenous infusions) to give you blood transfusions, and fluids until you are eating and drinking again
• One or more drains coming out of your abdomen near your wound - these stop blood, bile and tissue fluid collecting around the operation site
• A tube down your nose into your stomach (nasogastric tube) to drain it and stop you feeling sick - this is usually taken out about 2 to 4 days after surgery
• A tube into your bladder (catheter) so that your urine output can be measured

If you have had an oesophagogastrectomy, you will also have a drainage tube into your chest. The tube may connect to a suction bottle. The gentle suction helps your lung to inflate properly again after your chest has been operated on.

When you first wake up you will have a small tube (cannula) in an artery in your arm which is connected to a monitor to measure your blood pressure. Once you are well enough this will change to a blood pressure cuff on your arm. You will have a little clip on your finger to measure your pulse and the level of oxygen in your blood. This is called a pulse oximeter. 

You may also have an oxygen mask on for a while. Your blood pressure will be measured often for the first few hours after you come round from the anaesthetic. The nurses will measure how much urine you pass because it can help to show whether you have too much fluid or are getting dehydrated.

Painkillers

When you come round, you may have a couple of electronic pumps attached to your drips. One of these might have painkillers in it. You may have a hand control with a button to press to give yourself extra painkillers, as you need them. This is called PCA or patient controlled analgesia.

Some hospitals use painkillers given into the spine (epidural) for the first few days after surgery. This usually works very well. You will have a very fine tube taped to your back. This connects to a pump, which gives you a continuous dose of painkiller into your spine. Tell your nurse if you still have pain and they can increase the dose.

You will almost certainly have some pain for the first week or so after your operation. But there are painkilling drugs that work very well. It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly. If you have a button you can press to give yourself extra painkillers (PCA), do use it whenever you need to. You can’t overdose because the machine is set to prevent that. Tell your nurse if you need to press the button very often as you may need a higher dose in the pump.

Eating and drinking

After surgery to any part of the digestive system, the bowel often stops working for a while. You will not be able to eat or drink straight away and so you have fluids through a drip. 

During your surgery, the surgeon may have put a feeding tube (jejunostomy) into part of your small bowel called the jejunum. If so, you will be fed through this tube from about 24 hours after your operation. Another way of giving liquid food is through a tube down your nose and into the bowel (a nasojejunal tube).

You may be able to start drinking small amounts of water about 48 hours after surgery. Because you have had surgery to your stomach, and may have had it totally removed, you need to start drinking very gradually at first. You will start with sips of clear fluids. If you manage those, the amount you can have will slowly be increased. Then you can move on to other drinks such as milk, tea and soup. Once you are able to drink without feeling or being sick, your nurse will take your drip out.

If there is any concern that there is a leak where the surgeon stitched the stomach or intestine together you will have an X-ray. Before the X-ray, you swallow a type of dye called Gastrograffin. This shows up on the X-ray so that your doctor can see any leaks clearly.

Your wound

Your wound will be covered up with a dressing when you come round. It will be left covered for a couple of days. Then the dressings will be changed and the wound cleaned. The wound drains will be left in until they stop draining fluid. If they have bottles attached to them, these will be changed every day. Wound drains can usually be taken out about 3 to 7 days after your operation. Your stitches or clips will be left in for at least 10 days.

Getting up and about

Your nurses and physiotherapist will encourage you to get up and about as soon as possible as it helps you to recover more quickly. They will help you to sit out in a chair at least 6 to 12 hours after your operation. The next day they will help you walk around your bed. Within a few days you will hopefully be able to walk along a hospital corridor with help. Your physiotherapist will visit you every day to help you with your breathing and leg exercises.

Gradually your drips and drains will come out so it will be easier to get around. Then it will really feel that you are making progress. You will probably be able to go home about 10 days after your operation.

Making progress

After a few days you will be able to be up and about more. Gradually you will start to feel better. Soon you will be able to eat more. At first you will find it easier to have lots of very small meals rather than 3 large meals a day. It can take a long time to get back to having only 3 meals and some people prefer to carry on eating little and often. You will see the dietician throughout your hospital stay and before you go home. They will give you help and advice with managing your diet. You may be advised to take regular vitamins and eat iron rich foods.

You may have a vitamin B12 injection before you leave the hospital. If you have had most or all of your stomach removed, you will no longer be able to take in vitamin B12 from your food. You will need these injections from your GP regularly.

There is more about diet after stomach surgery in the living with stomach cancer section.