Total Gastrectomy for CDH-1 Mutation Carriers: An Institutional Experience

Area of Science:

• Oncology
• Gastroenterology
• Genetics

Background:

• Gastric cancer is a significant global health issue.
• Germline CDH1 gene mutations confer a high lifetime risk for diffuse gastric cancer.
• Prophylactic gastrectomy is recommended for individuals with CDH1 mutations, but outcomes data are limited.

Purpose of the Study:

• To describe the outcomes of total gastrectomy with intestinal pouch reconstruction in patients with CDH1 mutations.
• To evaluate postoperative morbidity and weight loss in this cohort.

Main Methods:

• A single-institution series of ten patients with confirmed CDH1 mutations who underwent total gastrectomy between 2010 and 2018.
• Patients underwent either cancer-directed or prophylactic gastrectomy.
• Outcomes assessed included presenting symptoms, preoperative screening, clinicopathologic features, weight loss, and postoperative complications.

Main Results:

• Eight of ten patients underwent prophylactic gastrectomy; three had occult gastric cancer detected pathologically.
• Median weight loss was 10 kg at 6 months and 11 kg at 1 year post-surgery.
• Postoperative morbidity was low, with one case each of anastomotic leak, hematoma, and pneumonia. All patients remained disease-free.

Conclusions:

• Total gastrectomy with jejunal pouch reconstruction is an effective cancer-preventing operation for individuals with CDH1 mutations.
• The procedure demonstrated encouragingly low postoperative morbidity and weight loss, with good functional outcomes.