Outcomes after prophylactic gastrectomy for hereditary diffuse gastric cancer

Area of Science:

• Oncology
• Surgical Gastroenterology
• Genetics

Background:

• Hereditary diffuse gastric cancer (HDGC) patients with CDH1 mutations face a 60-80% lifetime risk of developing gastric cancer.
• Total prophylactic gastrectomy removes this risk but is linked to substantial morbidity.
• The study evaluates the effectiveness and outcomes of prophylactic gastrectomy in this high-risk population.

Purpose of the Study:

• To assess the effectiveness of prophylactic gastrectomy in eliminating gastric mucosa in patients with CDH1 mutations.
• To evaluate the short-term and long-term outcomes and morbidity associated with this procedure.
• To provide data for counseling individuals with inherited predispositions to diffuse gastric cancer.

Main Methods:

• Retrospective analysis of consecutive patients undergoing prophylactic gastrectomy for CDH1 mutation or gastric signet ring cell foci (2005-2017).
• Intraoperative frozen-section examination of proximal resection margins used in 25 of 26 patients to ensure complete mucosal removal.
• Follow-up data collected on complications, nutritional status, functional outcomes, and return to work/study.

Main Results:

• Complete removal of gastric mucosa was achieved in all patients, with re-resection of the proximal margin in nine cases.
• Within the first year, five patients required relaparotomy for complications (adhesiolysis, jejunostomy issues).
• Significant weight loss (mean 15%) and increased functional complaints (bile reflux, dumping) were observed at one year post-surgery.

Conclusions:

• Prophylactic gastrectomy effectively eliminates gastric cancer risk in HDGC patients.
• Considerable morbidity and functional consequences necessitate careful patient counseling.
• Intraoperative frozen-section examination is recommended to ensure complete removal of risk-bearing gastric mucosa.