Outcomes after Prophylactic Total Gastrectomy for Hereditary Diffuse Gastric Cancer

Introduction Prophylactic total gastrectomy is the treatment of choice in patients with germline mutation in the CDH1 gene and therefore high risk for hereditary diffuse gastric cancer (HDGC). Minimally invasive techniques have been established in recent years for treatment of gastric cancer. Methods We report findings with 12 patients with proven CDH1 mutation who underwent multidisciplinary treatment between 2013 and 3/2018 in our centre for hereditary tu-mour diseases, followed by prophylactic total gastrectomy in our department. Data were collected in a prospective hereditary tumour database. Results Open prophylactic total gastrectomy was performed in 5 patients (between 2013 and 2015) andminimally invasive prospective gastrectomy in 7 patients (between 2015 and 2018). The median age of all patients (7 women and 5 men) was 42 (range: 19-60) years. The mean operation time was 291 +/- 72 minutes (open: 269 +/- 70; minimally invasive: 307 +/- 75). Perioperative 60-day mortality and anastomotic leakage rate were 0%. In 3 patients, postoperative complications occurred (according to the Clavien-Dindo classification: one each of grades II, IIIa and IVb, respectively), and therefore 25% morbidity. The average postoperative hospital stay was 14.5 +/- 6.2 days (open: 16.2 +/- 7.9; minimally invasive: 13.3 +/- 5.0). In 10 of 12 patients (83%), foci of intramucosal signet ring cell carcinomas were found in the gastric specimen, in 9 patients with multifocal dissemination. There were no cases with advanced carcinomas (>= pT1b) or lymph node metastases. Conclusion Patients with suspected high risk for hereditary diffuse gastric cancer should be cared for in a multidisciplinary centre for hereditary tumour diseases. Laparoscopic total gastrectomy is a safe and feasible risk-reducing procedure for patients with CDH1 germline mutation. Therefore, in the absence of contraindications and with available surgical expertise, the minimally invasive operation should be the standard procedure for these patients.