154 Impact of Prophylactic Total Gastrectomy (PTG) on Long-Term Health-Related Quality of Life in Patients with Hereditary Diffuse Gastric Cancer

Abstract Introduction Hereditary diffuse gastric cancer is predominantly attributed to germline mutation in the CDH1 gene and is associated with a 30-fold increased risk of advanced gastric cancer by the age of 30. Definitive treatment remains PTG but this significantly impacts short-term health-related quality of life (QOL). It is not established if QOL is impaired in the long-term and this study aimed to evaluate this prospectively. Method Prospectively consenting patients undergoing PTG at a national referral centre were included in the familial gastric cancer study between 2005 and 2025. Self-reported QOL data were collected using the validated EORTC QLQ-C30 and QLQ-STO22 questionnaires pre-operatively and at serial post-operative timepoints. Results Both pre-operative and post-operative QOL data were available for 30 patients with follow-up data greater than 5 years in 70%. Symptoms were prevalent in the first 3 months post-op but most recovered by 24 months. Symptoms of diarrhoea, fatigue, appetite loss, reflux and eating difficulties, however, persisted at a level above baseline. Despite these chronic symptoms, physical, social, cognitive and emotional functional domains recovered by 12 months post-operatively and remained stable at baseline levels up to 10 years and beyond. Anxiety symptoms also improved below baseline in long-term follow-up. Conclusions A high prevalence of post-operative symptoms is noted early post-PTG yet many recover to baseline by 2 years. Despite some ongoing symptoms, most patients recover functional levels to baseline by 12 months and this is preserved at >10 years post-op within the context of regular multidisciplinary specialist follow-up.