[Outcomes after Prophylactic Total Gastrectomy for Hereditary Diffuse Gastric Cancer]

Area of Science:

• Oncology
• Surgical Gastroenterology
• Genetics

Background:

• Germline mutations in the CDH1 gene confer a high risk of hereditary diffuse gastric cancer (HDGC).
• Prophylactic total gastrectomy is the established treatment for individuals with CDH1 mutations.
• Minimally invasive surgical techniques are increasingly utilized for gastric cancer treatment.

Purpose of the Study:

• To evaluate the safety and efficacy of prophylactic total gastrectomy in patients with CDH1 mutations.
• To compare outcomes between open and minimally invasive surgical approaches.
• To assess the incidence of gastric cancer in patients undergoing prophylactic surgery.

Main Methods:

• Retrospective analysis of 12 patients with confirmed CDH1 mutations undergoing prophylactic total gastrectomy between 2013 and 2018.
• Data collected prospectively in a hereditary tumor database.
• Comparison of open (n=5) versus minimally invasive (n=7) gastrectomy outcomes.

Main Results:

• No perioperative mortality or anastomotic leakage observed.
• Overall morbidity was 25% (Clavien-Dindo grades II, IIIa, IVb).
• 83% of patients (10/12) had intramucosal signet ring cell carcinomas detected, with 9 showing multifocal disease. No advanced cancers or lymph node metastases were found.

Conclusions:

• Patients at high risk for HDGC should receive care at specialized multidisciplinary centers.
• Laparoscopic total gastrectomy is a safe, feasible, and risk-reducing procedure for CDH1 mutation carriers.
• Minimally invasive surgery should be the standard approach when feasible and without contraindications.