Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;29(1):101889.
doi: 10.1016/j.gassur.2024.101889. Epub 2024 Nov 13.

Lessons learned from 150 total gastrectomies for prevention of cancer

Amber F Gallanis  1 , Cassidy Bowden  1 , Rachael Lopez  2 , Lauren A Gamble  1 , Sarah G Samaranayake  1 , Charlotte Payne  1 , Deborah Snyder  3 , Grace-Ann Fasaye  4 , Stacy Joyce  1 , Riema Broesamle  1 , Ning Miao  5 , Markku Miettinen  6 , Martha Quezado  6 , Sun A Kim  6 , Louis Korman  7 , Theo Heller  7 , Andrew M Blakely  1 , Jonathan M Hernandez  1 , Jeremy L Davis  8
Affiliations

Lessons learned from 150 total gastrectomies for prevention of cancer

Amber F Gallanis et al. J Gastrointest Surg. 2025 Jan.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: CDH1; Enhanced recovery after surgery; Hereditary diffuse gastric cancer; Prophylactic total gastrectomy.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest

The authors declare no competing interests.

Figures

Figure.
Figure.
Enhanced recovery after total gastrectomy pathway. POD, postoperative day; NPO, nothing by mouth .
See this image and copyright information in PMC

References

    1. Strong VE, Gholami S, Shah MA, Tang LH, Janjigian YY, Schattner M, et al. Total gastrectomy for hereditary diffuse gastric cancer at a Single Center: postsurgical outcomes in 41 patients. Ann Surg 2017;266(6):1006–12. 10.1097/sla.0000000000002030 - DOI - PubMed
    1. Stillman MD, Kusche N, Toledano S, Hilfrank KJ, Yoon C, Gabre JT, et al. Short and long-term outcomes of prophylactic total gastrectomy in 54 consecutive individuals with germline pathogenic mutations in the CDH1 gene. J Surg Oncol 2022;126(8):1413–22. 10.1002/jso.27084 - DOI - PMC - PubMed
    1. Vos EL, Salo-Mullen EE, Tang LH, Schattner M, Yoon SS, Gerdes H, et al. Indications for total gastrectomy in CDH1 mutation carriers and outcomes of risk-reducing minimally invasive and open gastrectomies. JAMA Surg 2020;155(11):1050–7. 10.1001/jamasurg.2020.3356 - DOI - PMC - PubMed
    1. Guilford P, Hopkins J, Harraway J, McLeod M, McLeod N, Harawira P, et al. E-cadherin germline mutations in familial gastric cancer. Nature 1998;392(6674):402–5. 10.1038/32918 - DOI - PubMed
    1. Stoll J, Kupfer SS. Risk assessment and genetic testing for inherited gastrointestinal syndromes. Gastroenterol Hepatol (N Y) 2019;15(9):462–70. - PMC - PubMed

MeSH terms