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

Research output: Contribution to journalArticlepeer-review

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
StatePublished - Dec 1 2015
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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