Total Gastrectomy

Total Gastrectomy: Recent Clinical Studies Examining Outcomes

Total gastrectomy is a modern development in medicine. From 2005 to 2018, several centers have studies outcomes of this procedure. Below, details of the studies are listed for comparison. At the end, I’ve included a table with the same information as the list. The table is hard to read in some respects because of limitations in my website skills, but I’ve included it anyway because it nonetheless might help you compare the study results.

Combined, the studies included 64 patients. The median age is in the mid-40s, with age ranges between 19 and 71 years. The studies also include both males, with about twice as many females as males. The studies also examined both open and minimally invasive techniques.

Total Gastrectomy Surgery: Should I Do It?

Based on these studies, the risk of death ranges between 0% and 2.5%. In addition, patients have a 25% to 36% chance of experiencing a complication that requires medical attention. Finally, in 82% to 85% of patients, at least 1 foci of intramucosal signet ring cell gastric cancer existed upon examining the removed stomach.

total-gastrectomy
total-gastrectomy

Study Titles

A: Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 Patients

B: Outcomes after Prophylactic Total Gastrectomy for Hereditary Diffuse Gastric Cancer

C: Prophylactic Laparoscopic Total Gastrectomy with Jejunal Pouch Reconstruction in Patients Carrying a CDH1 Germline Mutation

Patient Numbers

A: 41 patients

B: 12 patients

C: 11 patients

Median Age

A: 47 years

B: 42 years

C: 40 years

Age Range

A: 20 to 71 years

B: 19 to 60 years

C: 22–61 years

Women

A: 27 patients

B: 7 patients

C: 8 patients

Men

A: 14 patients

B: 5 patients

C: 3 patients

Open Surgery

A: 25 patients

B: 5 patients

C: 0 patients

Minimally Invasive Surgery

A: 16 patients

B: 7 patients

C: 11 patients

Median Hospital Stay

A: 7 days

B: 14.5 days

C: 10 days

Hospital Stay Range

A: 4 to 50 days

B: 8 to 21 days

C: 7 to 27 days

Complications

A: 11 patients (27%)

B: 3 patients (25%)

C: 4 patients (36%)

Deaths

A: 1 patient (2.5%)

B: 0 patients (0%)

C: 0 patients (0%)

Patients with at least 1 foci of intramucosal signet ring cell gastric cancer

A: 35 patients (85%)

B: 10 patients (83%)

C: 9 patients (82%)

Notes

A: Median weight loss was 15% (median follow-up at 16 months); Weight stabilized at 6 to 12 months post-op: 45% of patients reported their outcome to be “as expected”; 40% of patients reported their outcome to be “better than expected”; No patients had developed gastric cancer recurrence after total gastrectomy

B: No patients had advanced carcinomas (≥ pT1b); No patients had lymph node metastases; No patients experienced leakage

C: 2 patients experienced esophagojejunal anastomotic leakage; The leakages occurred in patients 2 and 3 and, therefore, are attributed to a surgical learning curve; Patients 4-11 did not develop anastomotic leakage; 1 patient with atelectasis experienced pulmonary complications; 1 patient with pneumonia experienced pulmonary complications

Conclusions

A: All CDH1 mutation carriers should consider total gastrectomy; CDH1 carriers have a high risk of developing invasive diffuse-type gastric cancer; No reliable surveillance options currently exist

B: Multidisciplinary centers experienced with treating patients at risk of developing hereditary tumour diseases should care for CDH1 patients; Laparoscopic total gastrectomy is safe and feasible for reducing the risk of stomach cancer in CDH1 mutation carriers; Minimally invasive surgery should be the standard for prophylactic total gastrectomy in CDH1 mutation carriers

C: Prophylactic total gastrectomy is recommended for CDH1 mutation carriers; Laparoscopic total gastrectomy for CDH1 mutation carriers is feasible and safe; Jejunal pouch reconstruction in CDH1 mutation carriers is feasible and safe

Authors

A: Strong, et al.

B: Pantelis, et al.

C: Haverkamp, et al.

Study Timeframe

A: 2005-2015

B: 2013-2018

C: 2006-2015

Publication Date

A: December 2017

B: August 2018

C: October 2015

total-gastrectomy
total-gastrectomy

Here is a video of the Spring 2017 Spotlight on Stomach Cancer Event held at the Fred Hutchinson Cancer Research Center in Seattle, Washington.

TABLE OF THE SAME INFORMATION ABOVE

StudyTotal Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 PatientsOutcomes after Prophylactic Total Gastrectomy for Hereditary Diffuse Gastric CancerProphylactic Laparoscopic Total Gastrectomy with Jejunal Pouch Reconstruction in Patients Carrying a CDH1 Germline Mutation
Patient Number41 patients12 patients11 patients
Median Age47 years42 years40 years
Age Range20 to 71 years19 to 60 years22–61 years
Women27 patients7 patients8 patients
Men14 patients5 patients3 patients
Open25 patients5 patients0 patients
Minimally Invasive16 patients7 patients11 patients
Median Hospital Stay7 days14.5 days10 days
Hospital Stay Range4 to 50 days± 6.2 days7 to 27 days
Complication11 patients (27%)3 patients (25%)4 patients (36%)
Death1 patient (2.5%)0 patients (0%)0 patients (0%)
Patients with at least 1 foci of intramucosal signet ring cell gastric cancer35 patients (85%)10 patients (83%)9 patients (82%)
NotesMedian weight loss was 15% (median follow-up at 16 months)
Weight stabilized at 6 to 12 months post-op
45% of patients reported their outcome to be “as expected”
40% of patients reported their outcome to be “better than expected”
No patients had developed gastric cancer recurrence after total gastrectomy
No patients had advanced carcinomas (≥ pT1b)
No patients had lymph node metastases
No patients experienced leakage

2 patients experienced esophagojejunal anastomotic leakage
The leakages occurred in patients 2 and 3 and, therefore, are attributed to a surgical learning curve
Patients 4-11 did not develop anastomotic leakage
1 patient with atelectasis experienced pulmonary complications
1 patient with pneumonia experienced pulmonary complications
ConclusionsAll CDH1 mutation carriers should consider total gastrectomy
CDH1 carriers have a high risk of developing invasive diffuse-type gastric cancerNo reliable surveillance options currently exist
Multidisciplinary centers experienced with treating patients at risk of developing hereditary tumour diseases should care for CDH1 patients
Laparoscopic total gastrectomy is safe and feasible for reducing the risk of stomach cancer in CDH1 mutation carriers
Minimally invasive surgery should be the standard for prophylactic total gastrectomy in CDH1 mutation carriers
Prophylactic total gastrectomy is recommended for CDH1 mutation carriersLaparoscopic total gastrectomy for CDH1 mutation carriers is feasible and safeJejunal pouch reconstruction in CDH1 mutation carriers is feasible and safe
AuthorsStrong, et al.Pantelis, et al.Haverkamp, et al.
Study Timeframe2005-20152013-20182006-2015
Publication DateDecember 2017August 2018October 2015

Prophylactic Total Gastrectomy: When Should I Have It?

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total-gastrectomy
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cdh1gene

CDH1 mutation carrier. Thriving without a stomach since June 1, 2018. Although I do not have a medical degree, I have been researching, writing about, and orally explaining complicated medical and biotechnology issues since 2005. I excel at understanding and organizing complicated technical issues and explaining them in simple terms. I hope you benefit from my work on CDH1 mutations and total gastrectomies. Visit www.jonegrossman.com for information about patents, trademarks, and starting an online business. Visit www.yogainthewind.com for articles about yoga and healthy eating.

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