Life was going on as usual until one day 38-year-old engineer Ghulam Abbas needed to make a choice — life without a stomach, or dying from stomach cancer.
“It’s the most devastating decision and yet the answer was clear — I had to do whatever it took to save my life,” says Abbas. “I did not want my children to grow up without my presence; I did not want to lose the opportunity to see their milestones, watch them laugh, even fight. I was not going to give up on my family and me. I just wanted to hold on to life.
“I had only one question. How would I be able to survive without a stomach?”
Abbas was diagnosed with stage three cancer after he walked into Rashid Hospital’s Gastroenterology clinic complaining of sudden weight loss and vomiting. Tests revealed he had a huge tumour that covered almost his entire stomach.
Gastric cancer is the second-leading cause of cancer-related death and the fourth-most common cancer worldwide.
“In young patients unfortunately the cancer is very aggressive,” says Dr Ali Khammas Alyammahi, Head of General Surgery and Consultant Laparoscopic Surgeon at Rashid Hospital. “There was no option but to conduct a total gastrectomy. We decided to perform the minimally invasive surgery, which has multiple advantages as opposed to open surgery. We have performed several colon cancer surgeries using this technique but a total gastrectomy was the first of its kind in Dubai.”
Before the surgery, doctors wanted to evaluate Abbas’ response to chemotherapy. “Sometimes in aggressive cancers of this kind, the tumour increases in size and spreads rapidly even while the patient is on chemotherapy,” says Dr Omar Al Marzouqi, Consultant Laparoscopic Surgeon. “We do not expose such patients to surgery. After two months of chemotherapy at Dubai Hospital, his tumour shrunk in size, so we decided to go ahead with the surgery.”
“After chemotherapy I felt better,” says Abbas. “I was on nasal feed for two months and post chemotherapy. I hoped that chemotherapy would be enough to tackle the tumour.”
However, Abbas was informed that chemotherapy only shrunk the tumour but leaving a cancerous tumour inside the stomach was a ticking time bomb. He was left with no option but to undergo surgery.
“I was relieved to know that it would be a minimally invasive surgery. It meant that I could have a chance to recover quickly.”
However, he had one wish before the surgery. “I asked the doctor if I could have chicken biryani as my last meal before the surgery. My wife prepared it and my brother carried it to the hospital. I sort of gorged on it!”
The next day Abbas went into a five-hour surgery. Dr Al Marzouqi performed the surgery with his team.
“Traditionally such a surgery would involve opening up the abdomen vertically from the stomach to the pelvis but minimally invasive surgery is the way forward in many cases as it is less invasive and leads to much faster recovery time,” he says.
“For colon cancer cases we have used this method several times but this type of surgery was the first in Dubai. We laparoscopically removed the total stomach and the lymphatic drainage system from the root. We then reconstructed the whole area in such a way that the small bowel (small intestine) functions as the stomach.”
The surgery was a success: the pathology report showed that the surrounding area was also free of cancer cells. “In medicine there are markers for quality assurance. In such surgeries, the minimum number of lymph nodes that need to be removed are 26; we got more than double — we were able to remove 56 nodes.”
Abbas is still undergoing chemotherapy at Dubai Hospital as a preventive measure. “It is normal to question how a person can live without a stomach,” Dr Al Marzouqi says. “However, the body is able to bypass the stomach’s main function of storing and breaking down food and gradually pass that to the intestines. Without a stomach, food consumed in small quantities can move directly from the oesophagus to the small intestine.”
Abbas needs to be very mindful of the quantities he consumes though. He has to nourish his body in tiny meals throughout the day. “Here the credit goes to my wife,” he says.
“She meticulously prepares small meals for me and I keep track of how often I need to eat. Post the surgery I was on watery liquids and then I moved on to thick liquids. I will soon start consuming small non-spicy meals.
“I’ve adapted to this new pattern. Things could have been worse. I’m here, alive, what more could I possibly ask for?”