International Delphi consensus guidelines for follow-up after prophylactic total gastrectomy: the Life after...

Area of Science:

• Oncology
• Gastroenterology
• Genetics

Background:

• Prophylactic total gastrectomy (PTG) is the sole method for preventing gastric cancer in individuals with hereditary diffuse gastric cancer (HDGC), primarily linked to CDH1 gene mutations.
• A growing population of young individuals undergoing PTG anticipates normal life expectancy, yet long-term effects and monitoring needs post-PTG are not well-defined.
• This study addresses the need for standardized follow-up care protocols after PTG.

Purpose of the Study:

• To establish a standard of care for post-prophylactic total gastrectomy (PTG) follow-up.
• To provide evidence-based recommendations for managing patients after PTG.
• To create a framework for collecting long-term data on PTG outcomes.

Main Methods:

• A comprehensive literature review was conducted.
• A two-round Delphi consensus process involved major HDGC/PTG centers, physicians, and patient advocates.
• Recommendations were developed based on expert consensus and literature review.

Main Results:

• The consensus involved 42 first-round and 62 second-round responses from clinicians, allied health professionals, and patient advocates.
• Guidelines cover assessment timing, involved specialties, micronutrient monitoring, bone health, and patient information provision.
• The developed guidelines offer a structured approach to post-PTG management.

Conclusions:

• Expert consensus provides a crucial framework for managing patients post-PTG, despite limited supporting evidence.
• These guidelines can facilitate the collection of vital information regarding the long-term effects of PTG.
• Standardized follow-up care is essential for optimizing outcomes in HDGC patients who have undergone PTG.