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for endoscopic resection","Selected palliative cases such as bleeding or obstruction"],"main_risks":["Anastomotic or duodenal stump leak","Infection, abscess, wound complications","Bleeding","Pneumonia and thromboembolism","Delayed gastric emptying","Dumping syndrome, reflux, weight loss and malnutrition","Vitamin B12 and iron deficiency (especially after total gastrectomy)","Anastomotic stricture"],"pain":"Moderate to significant postoperative pain for the first several days, managed with multimodal analgesia (epidural or regional blocks, oral/IV analgesics); less with laparoscopic approach.","preparation":["Staging (endoscopy with biopsy, CT, sometimes EUS or laparoscopy)","Multidisciplinary tumor board review","Nutritional assessment and optimization","Cardiopulmonary and anesthesia assessment","Smoking cessation and prehabilitation where possible","Fasting before surgery per anesthesia team instructions","Review of current medications with the care team"],"recovery_timeline":[{"phase":"Hospital stay (days 0-10)","description":"Early mobilization, gradual return to oral intake, monitoring for leaks and complications.","restrictions":["Progressive diet from liquids","No heavy lifting"]},{"phase":"Early home recovery (days 10-42)","description":"Small frequent meals, wound healing, fatigue improving; pathology review and adjuvant therapy planning.","restrictions":["No lifting over about 5 kg","Avoid strenuous activity"]},{"phase":"Late recovery (weeks 6-12)","description":"Gradual return to normal activity and diet adaptation; nutritional supplementation as needed.","restrictions":["Increase exercise gradually after surgeon clearance"]}],"rehabilitation_days":{"min":28,"max":60,"unit":"days","qualifier":"Ordinary functional recovery after uncomplicated gastrectomy; dietary adaptation may continue longer."},"result_longevity":"Anatomical changes are lifelong. Long-term outcome depends on cancer stage, margins and adjuvant therapy; recurrence is possible, so surveillance is needed for at least 5 years.","revision_rate_pct":{"min":2,"max":6,"unit":"percent","qualifier":"Unplanned reoperation within 30-90 days, mainly for leak, bleeding or obstruction."},"scars":"Midline or upper abdominal incision scar after open surgery; several small port-site scars after laparoscopic or robotic surgery, plus a small extraction incision.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single operation; perioperative chemotherapy is separate and not included."},"stages":[{"code":"gastrectomy","label":"Partial or total gastrectomy with lymphadenectomy and reconstruction","after":{"min":0,"max":0,"unit":"days","qualifier":"Single operative session."}}],"qualifier":"Uncomplicated primary curative gastrectomy."},"success":{"metric":"5-year overall survival after curative gastrectomy","value":60,"unit":"percent","horizon":"5 years","population":"Adults with resectable gastric adenocarcinoma, all stages combined, treated with curative intent","evidence_status":"limited"},"techniques":[{"name":"Total gastrectomy with Roux-en-Y reconstruction","suits_whom":"Patients with proximal or middle-stomach tumors or diffuse-type cancer.","recovery":"Longer recovery and greater nutritional impact."},{"name":"Distal (subtotal) gastrectomy","suits_whom":"Patients with distal tumors where an adequate margin allows a proximal remnant.","recovery":"Generally faster recovery with better nutrition than total gastrectomy."},{"name":"Laparoscopic or robotic gastrectomy","suits_whom":"Selected patients, particularly early or less advanced tumors, in experienced centers.","recovery":"Often shorter hospital stay and less pain than open surgery."}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":3,"max":6,"unit":"hours","qualifier":"Operative time for a single gastrectomy with lymphadenectomy and reconstruction."},"initial_assessment_documents":["Gastroscopy report with biopsy pathology","Contrast-enhanced CT scan of chest and abdomen","Endoscopic ultrasound report (if available)","PET-CT report (if available)","Recent blood tests including hemoglobin and albumin","HER2 and MSI status report (if available)"],"travel_trips":{"min":1,"max":2,"one_trip_possible":true,"qualifier":"Single operation; stay about 10-14 days including recovery before flight. Second trip only for surveillance or adjuvant care."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Ask how many total gastrectomy operations the surgeon performs each year","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"How many total gastrectomy operations do you perform each year?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C2","text":"Ask the surgeon for their personal complication rate with this operation","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"What is your personal complication rate with this operation?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C3","text":"Ask whether the surgeon checks margins in the operating room to confirm all gastric tissue is removed","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"Do you check margins in the operating room to confirm that all gastric tissue has been removed?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C4","text":"Ask whether the surgeon routinely places a feeding tube during this operation","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"Do you routinely place a feeding tube during this operation?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C5","text":"Ask who will be responsible for your post-gastrectomy care if the surgeon is not your follow-up contact","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"If the surgeon will not be your primary point of contact for follow-up after surgery, make sure to ask who will be responsible for your post-gastrectomy care.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C6","text":"Ask whether you can speak with other patients who had this operation with the surgeon","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"Can I speak to other patients who have had this operation with you?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C7","text":"Ask whether a registered dietitian is available before surgery","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"Will I meet with a registered dietitian before surgery?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"Surgeon avoids giving their own complication figures when asked about them","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"Most surgeons keep track of their own complications, or their hospital likely does, and they will be forthcoming about their own outcomes and how they manage them.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F2","text":"No dietitian meeting is offered before surgery, though it matters as much as after","scope":"procedure","source":{"url":"https://ccr.cancer.gov/surgical-oncology-program/clinical-team/questions-to-ask-your-surgeon","host":"ccr.cancer.gov","quote":"Meeting with a registered dietitian before surgery is as important as meeting with one after.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F3","text":"The care team does not discuss what to expect before treatment starts","scope":"treatment_type","source":{"url":"https://www.cancer.gov/types/stomach/patient/stomach-treatment-pdq","host":"cancer.gov","quote":"Talking with your cancer care team before treatment begins about what to expect will be helpful.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F4","text":"Treatment plan is set without the patient and care team working together on it","scope":"treatment_type","source":{"url":"https://www.cancer.gov/types/stomach/patient/stomach-treatment-pdq","host":"cancer.gov","quote":"You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Difficulty swallowing or food getting stuck","urgency":"contact_clinic","general":false,"source":{"url":"https://www.nhs.uk/tests-and-treatments/gastrectomy/recovery/","host":"nhs.uk","quote":"are having difficulty swallowing, or feel that food is getting stuck","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W2","text":"Losing weight quickly","urgency":"contact_clinic","general":false,"source":{"url":"https://www.nhs.uk/tests-and-treatments/gastrectomy/recovery/","host":"nhs.uk","quote":"are losing weight quickly","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W3","text":"Dizziness, faintness, or tummy cramps after eating","urgency":"contact_clinic","general":false,"source":{"url":"https://www.nhs.uk/tests-and-treatments/gastrectomy/recovery/","host":"nhs.uk","quote":"feel dizzy, faint, sick or have tummy cramps after you eat","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W4","text":"Heartburn that will not go away","urgency":"contact_clinic","general":false,"source":{"url":"https://www.nhs.uk/tests-and-treatments/gastrectomy/recovery/","host":"nhs.uk","quote":"have heartburn that will not go away","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T2","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge summary","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"When you have treatment abroad, you must ask the treatment provider for their follow-up recommendations documented within a written discharge summary in English.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T3","text":"Ask for copies of all prescriptions before you leave","document":"prescription copies","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Remember to ask for copies of all your treatment records, including prescriptions, scans and x-rays 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