Atousa Khiabany, Alexander A. Dermanis, Mei Sien Liew, Kai Ren Ong, Sivesh K. Kamarajah, Ewen A. Griffiths
{"title":"A Systematic Review of Surgical and Pathological Outcomes in Patients With a CDH1 Mutation Undergoing Total Gastrectomy","authors":"Atousa Khiabany, Alexander A. Dermanis, Mei Sien Liew, Kai Ren Ong, Sivesh K. Kamarajah, Ewen A. Griffiths","doi":"10.1002/jso.27855","DOIUrl":null,"url":null,"abstract":"Background<jats:italic>CDH1</jats:italic> (E‐cadherin) genetic mutations are associated with a 30%−70% increased lifetime risk of hereditary diffuse gastric cancer (HDGC). Although prophylactic total gastrectomy (PTG) reduces long‐term risk of gastric cancer, the associated morbidity and mortality remain unclear. This systematic review aims to characterise postoperative surgical outcomes in patients undergoing total gastrectomy.MethodsA systematic literature search was performed for studies reporting endoscopic surveillance, surgical and pathological outcomes for patients with <jats:italic>CDH1</jats:italic> mutation undergoing a total gastrectomy.ResultsThirty‐nine studies included 1849 patients, of which 96% had a <jats:italic>CDH1</jats:italic> (<jats:italic>n</jats:italic> = 1777) or CTNNA1 (<jats:italic>n</jats:italic> = 3) mutation. Endoscopy outcomes were reported for 1640 patients. Cancer foci were identified in 32% (<jats:italic>n</jats:italic> = 523/1640) and 71% of these patients went on to have a total gastrectomy (<jats:italic>n</jats:italic> = 369/523). The remaining 78% of patients did not have cancer foci detected on endoscopy (<jats:italic>n</jats:italic> = 1117/1640). Of these patients, 62% underwent a total gastrectomy (<jats:italic>n</jats:italic> = 688/1117) and 81% were found to have cancer on surgical histology (<jats:italic>n</jats:italic> = 556/688). Pathological staging was reported for 790 patients undergoing surgery, of which 68% had pT1 disease (<jats:italic>n</jats:italic> = 537). Postoperative complications were reported for 430 patients across 23 studies, with the most common complications being anastomotic strictures (25%), anastomotic leaks (13%), wound infections (12%) and pulmonary complications (11%). Only one postoperative death was reported within 30 days.ConclusionRates of early cancers are high in <jats:italic>CDH1</jats:italic> patients undergoing PTG, highlighting the need for improvement in reliable endoscopic surveillance. Although postoperative mortality in this surgical cohort remains low, high rates of postoperative complications warrant careful patient counselling.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.27855","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
BackgroundCDH1 (E‐cadherin) genetic mutations are associated with a 30%−70% increased lifetime risk of hereditary diffuse gastric cancer (HDGC). Although prophylactic total gastrectomy (PTG) reduces long‐term risk of gastric cancer, the associated morbidity and mortality remain unclear. This systematic review aims to characterise postoperative surgical outcomes in patients undergoing total gastrectomy.MethodsA systematic literature search was performed for studies reporting endoscopic surveillance, surgical and pathological outcomes for patients with CDH1 mutation undergoing a total gastrectomy.ResultsThirty‐nine studies included 1849 patients, of which 96% had a CDH1 (n = 1777) or CTNNA1 (n = 3) mutation. Endoscopy outcomes were reported for 1640 patients. Cancer foci were identified in 32% (n = 523/1640) and 71% of these patients went on to have a total gastrectomy (n = 369/523). The remaining 78% of patients did not have cancer foci detected on endoscopy (n = 1117/1640). Of these patients, 62% underwent a total gastrectomy (n = 688/1117) and 81% were found to have cancer on surgical histology (n = 556/688). Pathological staging was reported for 790 patients undergoing surgery, of which 68% had pT1 disease (n = 537). Postoperative complications were reported for 430 patients across 23 studies, with the most common complications being anastomotic strictures (25%), anastomotic leaks (13%), wound infections (12%) and pulmonary complications (11%). Only one postoperative death was reported within 30 days.ConclusionRates of early cancers are high in CDH1 patients undergoing PTG, highlighting the need for improvement in reliable endoscopic surveillance. Although postoperative mortality in this surgical cohort remains low, high rates of postoperative complications warrant careful patient counselling.
期刊介绍:
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.