Complications
Weight should be monitored regularly after gastrectomy.
Patients should be encouraged to eat more frequently and avoid fluid intake with meals. Patients may benefit from referral to a dietician. Other contributing medical and social factors should be considered.[25]
The most common adverse effects of PD-1 or PD-L1 inhibitor therapies are: anaemia (45.4%), fatigue (34.3%), dysphagia (30%), neutropenia (19.6%), lymphopenia (10.2%), hypertension (9.3%), and elevated lipase (7.2%).[102] Other potential adverse effects include colitis, myocarditis, pericarditis, and skin toxicities. Guidelines for monitoring of patients and management of complications are available.[103][104]
Recognised complication of surgical treatment.
Due to tissue ischaemia or technical error. Early diagnosis and surgical intervention is the key in limiting morbidity.
Recognised complication of surgical treatment.
Due to intestinal contamination or break in surgical sterile technique. Wound cellulitis can be treated with antibiotics; purulent drainage from wounds will require re-opening.
Recognised complication of surgical treatment.
Recognised complication of surgical treatment.
Cachexia affects approximately half of patients with advanced cancer.[100] Patients and carers should be educated regarding appropriate diets to be consumed. Routine use of enteral tube feeding or parenteral nutrition is not recommended.[100] Low-dose olanzapine is recommended to improve weight gain and appetite.[101] A short-term trial of a progesterone analogue or a corticosteroid is recommended in patients who cannot tolerate olanzapine.[101]
Common in gastric cancer survivors. Diet manipulation, bulk-forming agents, and anti-diarrhoeal medications can be considered.[25]
Common in gastric cancer survivors. Patients should be encouraged to undertake physical activity and advised on energy conservation measures.[25]
Short-term complications include febrile neutropenia, thrombocytopenia, and nausea.
Peripheral neuropathy is a frequent adverse effect of platinum-containing chemotherapy. Duloxetine may be considered for painful neuropathy, but is ineffective for numbness or tingling.[25]
Patients who have had subtotal distal or total gastrectomies are particularly at risk of nutritional deficiencies. Full blood count, serum B12, and iron should be monitored regularly, and replaced if low.[25]
Complication of subtotal gastrectomy. Patients should avoid foods that increase acid production (e.g., spicy food, citrus juices, tomato sauces) and foods that lower the oesophagogastric sphincter tone (e.g., peppermint, chocolate, caffeine). Proton pump inhibitor therapy may be helpful.[25]
Malignant intraluminal obstruction can result from local extension of the tumour. Patients present with nausea, vomiting, and anorexia.
Should be treated with surgery, endoluminal stenting, or radiation.[97]
Excessive bleeding can occur in a necrotic or ulcerated tumour.
Treated with arterial embolisation or endoscopic intervention, although patients may require surgery.
Chemoradiation can be considered in non-surgical candidates once stabilised if they continue to slowly bleed.[97]
Caused by erosion of the tumour through the wall of the stomach.
This is an emergency and often presents with shock and peritonitis.
Surgical evaluation should be performed immediately.[98]
Small bowel obstruction can result from peritoneal disease, which can cause extraluminal obstruction.
Treat with intravenous hydration and electrolyte replacement. Surgical consultation should be obtained immediately.
Prognosis is poor.[97]
Recognised complication of surgical treatment.
Recognised complication of surgical treatment. Caused by rapid entry of sugary foods into the duodenum. Early symptoms occur within 30 minutes of eating and include palpitations, diarrhoea, nausea, and cramps. Later symptoms occur 2-3 hours after a meal, and include dizziness, cold sweats, hunger, and faintness.[25]
Patients with dumping syndrome should eat regular, frequent meals. Diet should be low in simple carbohydrates and concentrated sugars, and high in protein and fibre.[25]
Include anorexia, thrombocytopenia, and nausea. A feeding tube in patients receiving upper abdominal radiation for nutrition may be considered.
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