Gallanis Amber F, Bowden Cassidy, Lopez Rachael, Gamble Lauren A, Samaranayake Sarah G, Payne Charlotte, Snyder Deborah, Fasaye Grace-Ann, Joyce Stacy, Broesamle Riema, Miao Ning, Miettinen Markku, Quezado Martha, Kim Sun A, Korman Louis, Heller Theo, Blakely Andrew M, Hernandez Jonathan M, Davis Jeremy L
Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States.
Clinical Center Nutrition Department, National Institutes of Health, Bethesda, MD, United States.
J Gastrointest Surg. 2025 Jan;29(1):101889. doi: 10.1016/j.gassur.2024.101889. Epub 2024 Nov 13.
Prophylactic total gastrectomy (PTG) is performed in carriers of CDH1 pathogenic and likely pathogenic (P/LP) variants and is becoming more frequent with broader use of germline genetic testing. There is an unmet need to standardize care and enhance outcomes among patients undergoing surgery for the prevention of gastric cancer.
This was a retrospective analysis of 150 individuals with germline CDH1 P/LP variants who underwent PTG as part of a prospective natural history study from October 2017 to May 2023. All individuals received multidisciplinary, protocolized care before and after total gastrectomy.
A total of 150 asymptomatic patients with germline CDH1 P/LP variants underwent PTG with the aid of a multidisciplinary enhanced recovery after surgery (ERAS) pathway. This study demonstrated that acute major morbidity (Clavien-Dindo grade of ≥3) was low (17/150 [11.3%]) and that the most common complication was anastomotic leak (11/150 [7.3%]) in the setting of a comprehensive preoperative and postoperative care pathway. Nearly all gastrectomy specimens (132/150 [88.0%]) harbored occult signet ring cell lesions on final pathology. There were no gastric cancer recurrences or gastric cancer-related deaths during the study period, with a median overall follow-up of 36 months (IQR, 24-48) from gastrectomy.
PTG can be performed with low surgical morbidity in a high-volume center. The delivery of patient-centered care by a multidisciplinary team and the application of an ERAS pathway may improve short-term outcomes. However, interventions that can reduce chronic morbidity associated with total gastrectomy warrant further study.
预防性全胃切除术（PTG）用于携带CDH1致病及可能致病（P/LP）变异的患者，随着种系基因检测的广泛应用，这种手术越来越常见。目前迫切需要规范对接受预防胃癌手术患者的护理并改善其治疗效果。
这是一项回顾性分析，研究对象为150名携带种系CDH1 P/LP变异的个体，他们于2017年10月至2023年5月期间作为一项前瞻性自然史研究的一部分接受了PTG。所有个体在全胃切除术前和术后均接受了多学科规范化护理。
共有150名无症状的携带种系CDH1 P/LP变异的患者借助多学科术后加速康复（ERAS）路径接受了PTG。本研究表明，在全面的术前和术后护理路径下，急性严重并发症（Clavien-Dindo分级≥3级）发生率较低（17/150 [11.3%]），最常见的并发症是吻合口漏（11/150 [7.3%]）。几乎所有胃切除标本（132/150 [88.0%]）在最终病理检查中都发现了隐匿性印戒细胞病变。在研究期间，没有胃癌复发或与胃癌相关的死亡病例，自胃切除术后的中位总随访时间为36个月（四分位间距，24 - 48）。
在高容量中心进行PTG手术时，手术并发症发生率较低。多学科团队提供以患者为中心的护理以及应用ERAS路径可能会改善短期治疗效果。然而，能够降低与全胃切除术相关的慢性并发症的干预措施值得进一步研究。
