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

L. Haverkamp, P. C. van der Sluis, M. G E M Ausems, S. van der Horst, P. D. Siersema, J. P. Ruurda, G. J A Offerhaus, R. van Hillegersberg

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Abstract

Background: For patients with an identified germline E-cadherin-1 (CDH1) mutation, prophylactic gastrectomy is the treatment of choice to eliminate the high risk of developing diffuse gastric cancer. Laparoscopic total gastrectomy with jejunal pouch reconstruction is a novel approach that may be especially suitable in these patients. Methods: Patients with a germline CDH1 mutation who underwent prophylactic laparoscopic total gastrectomy with jejunal pouch were included in our prospective database. Results: A total of 11 patients with a median age of 40 (22–61) years were included. The average operative time was 4:26 ± 0:49 h and the average blood loss was 219 ± 155 ml. Median length of hospital stay was 10 (7–27) days. In two patients, an esophagojejunal anastomotic leakage occurred (grade 4). The leakages were seen in patient numbers 2 and 3, which may be a result of a learning curve. The latter eight patients did not develop anastomotic leakage. Pulmonary complications occurred in one patient with atelectasis and in one patient with pneumonia (grade 2). The 60-day mortality rate was 0 %. Multiple foci of intramucosal diffuse gastric signet ring cell carcinoma were found in the resection specimen of 9/11 (82 %) patients. All 11/11 (100 %) resections were microscopically radical. Conclusions: Prophylactic laparoscopic total gastrectomy with jejunal pouch reconstruction in patients with a CDH1 germline mutation is feasible and safe. In 82 % of patients, foci of intramucosal diffuse gastric signet ring cell carcinoma in the resection specimen were found.

Original languageEnglish (US)
Pages (from-to)2120-2125
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number12
DOIs
Publication statusPublished - Dec 1 2015
Externally publishedYes

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Keywords

  • Cancer
  • E-cadherin
  • Gastrectomy
  • Laparoscopy
  • Prophylactic

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Haverkamp, L., van der Sluis, P. C., Ausems, M. G. E. M., van der Horst, S., Siersema, P. D., Ruurda, J. P., ... van Hillegersberg, R. (2015). Prophylactic Laparoscopic Total Gastrectomy with Jejunal Pouch Reconstruction in Patients Carrying a CDH1 Germline Mutation. Journal of Gastrointestinal Surgery, 19(12), 2120-2125. https://doi.org/10.1007/s11605-015-2963-4