Outcomes of minimally invasive and open prophylactic gastrectomy for hereditary diffuse gastric cancer

Background: Mutations in the CDH1 gene predispose individuals to hereditary diffuse gastric cancer.As these tumors can evade endoscopic screening, prophylactic total gastrectomy is often recommended.Since skill with minimally invasive surgery (MIS) has progressed, we compared CDH1 mutation carriers who underwent open vs MIS total gastrectomy.Methods: A retrospective review of 48 CDH1 carriers who underwent total gastrectomy from May 2004 to April 2023 was performed.Eight patients were excluded because they were symptomatic prior to surgery and had advanced signet ring cell adenocarcinoma.Results: Twenty-eight open and 12 MIS total gastrectomy patients were included; one MIS case was converted to open.The groups were comparable regarding age, comorbidities, and pre-operative carcinoma identified (42 % vs 36 %).Blood loss was lower with MIS gastrectomy (200 vs 23 mL) while operative time was longer (163 vs 286 minutes).The number of lymph nodes harvested (18 vs 23) and the percentage with carcinoma (86 % vs 92 %) were not different between open and MIS approaches.Length of stay was shorter after MIS gastrectomy (7 vs 5 days).In the MIS group, there were no major post-operative complications (2.5 % open) or readmissions within 90 days (11 % open).Subsequent surgery or dilation was infrequent (18 % vs 8 %).Less weight loss was seen after MIS gastrectomy, reaching significance at 9 months post-operatively (-25 % vs -13 %).Conclusions: MIS total gastrectomy is the preferred operation for CDH1 carriers, resulting in shorter hospitalization without compromising pathology or safety.Synopsis: Minimally invasive total gastrectomy performed for patients with CDH1 mutations has minimal shortor long-term complications and was associated with shorter length of stay and less weight loss than open total gastrectomy, without compromising lymph node yield or margin status.