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.
Study Titles
B: Outcomes after Prophylactic Total Gastrectomy for Hereditary Diffuse Gastric Cancer
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
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
| Study | Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 Patients | Outcomes after Prophylactic Total Gastrectomy for Hereditary Diffuse Gastric Cancer | Prophylactic Laparoscopic Total Gastrectomy with Jejunal Pouch Reconstruction in Patients Carrying a CDH1 Germline Mutation |
| Patient Number | 41 patients | 12 patients | 11 patients |
| Median Age | 47 years | 42 years | 40 years |
| Age Range | 20 to 71 years | 19 to 60 years | 22–61 years |
| Women | 27 patients | 7 patients | 8 patients |
| Men | 14 patients | 5 patients | 3 patients |
| Open | 25 patients | 5 patients | 0 patients |
| Minimally Invasive | 16 patients | 7 patients | 11 patients |
| Median Hospital Stay | 7 days | 14.5 days | 10 days |
| Hospital Stay Range | 4 to 50 days | ± 6.2 days | 7 to 27 days |
| Complication | 11 patients (27%) | 3 patients (25%) | 4 patients (36%) |
| Death | 1 patient (2.5%) | 0 patients (0%) | 0 patients (0%) |
| Patients with at least 1 foci of intramucosal signet ring cell gastric cancer | 35 patients (85%) | 10 patients (83%) | 9 patients (82%) |
| Notes | 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 | 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 |
| Conclusions | All 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 |
| Authors | Strong, et al. | Pantelis, et al. | Haverkamp, et al. |
| Study Timeframe | 2005-2015 | 2013-2018 | 2006-2015 |
| Publication Date | December 2017 | August 2018 | October 2015 |
Prophylactic Total Gastrectomy: When Should I Have It?
