[Preventive Surgery for Hereditary Gastric Cancer]

Hereditary diffuse gastric cancer (HDGC) caused by disease-causing variant in CDH1 or CTNNA1 and familial adenomatous polyposis (FAP, disease-causing variants in APC) require individualised cancer prevention strategies. In HDGC, prophylactic total gastrectomy is often recommended, whereas in FAP, endoscopic surveillance with interventions plays a central role. The choice of reconstruction (Roux-en-Y, jejunal interposition, double-tract) affects both duodenal accessibility and quality of life. Decisions between surveillance and surgery should be made individually, balancing cancer risk and postoperative quality of life.