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POST OPERATIVE OUTCOMES AND COMPLICATIONS OF CDH1 CARRIERS UNDERGOING PROPHYLACTIC GASTRECTOMY– RESULTS FROM THE GASTRIC CONSORTIUM
Ophir Gilad
*1, Melissa Heller
2, Taylor Apostolico
2, Michelle Jacobs
3, Maegan Roberts
4, Kebire Gofar
4, Beth Dudley
5, Eve Karloski
5, Souvik Saha
6, Keenan Nguyen
6, Yana Chertock
7, Christine Drogan
1, Emma Keel
1, Benjamin A. Lerner
8, George Hanna
8, Afshin Khan
9, Sarah Ertan
9, Kimberly Hillfrank
10, Sheila D. Rustgi
10, Aparajita Singh
9, Xavier Llor
8, Michael Hall
7, Randall Brand
5, Peter P. Stanich
4, Elena M. Stoffel
3, Sonia S. Kupfer
1, Ajay Bansal
6, Bryson W. Katona
21The University of Chicago, Chicago, IL; 2University of Pennsylvania, Philadelphia, PA; 3University of Michigan, Ann Arbor, MI; 4The Ohio State University Wexner Medical Center, Columbus, OH; 5University of Pittsburgh, Pittsburgh, PA; 6The University of Kansas Medical Center, Kansas City, KS; 7Fox Chase Cancer Center, Philadelphia, PA; 8Yale University, New Haven, CT; 9University of California San Francisco, San Francisco, CA; 10Columbia University, New York, NY
Background: Management of
CDH1 carriers is challenging, as there remains uncertainty about when to use endoscopic surveillance in place of prophylactic total gastrectomy (PTG) for gastric cancer risk management, especially when the latter may lead to considerable morbidity. Herein the multicenter GASTRIC (
Group of investig
Ators
STriving toward
Research
In
CDH1) Consortium aims to evaluate surgical outcomes and complications in
CDH1 carriers undergoing PTG.
Methods:
CDH1 pathogenic/likely pathogenic variant carriers were retrospectively identified from 10 academic centers in the United States. Surgical complications were entered from electronic medical records into a database management system. Association between continuous variables was assessed using Mann-Whiteny test, and chi-square or Fisher’s exact tests for categorical variables.
Results: To date, 279 carriers have been included, of these 145 (51.9%) underwent PTG. Baseline characteristics and outcomes are presented in
Table 1. Factors positively associated with a decision to undergo PTG were family history of gastric cancer (mean 2.7 family members vs. 1.4, p=0.001), gastric biopsies positive for signet ring cell carcinoma (73.5% vs. 51.5%, p=0.002), positive smoking status (86.7% vs. 56.3%, p=0.021) and non-Ashkenazi Jewish ancestry (57.7% vs. 20%, p=0.004).
All individuals lost weight after gastrectomy, with maximal median weight loss of 23.8% (IQR 18.6-31.5) which was noted 7.4 months after surgery. New weight equilibrium (of -20.3%,
Figure 1) was achieved 36 months after surgery.
Fifty-two individuals (35.8%) developed post-surgical complications, mainly anastomotic strictures (16.5%), leakage (7.5%) and abscess formation (5.5%). Only 42 individuals (28.9%) underwent bone loss evaluation after surgery, of which 19 (45.2%) were found to have osteopenia and 10 (23.8%) with osteoporosis. Pre-surgery bone density tests were available for 16 individuals and the median T-score significantly dropped from -1.05 to -1.5 (p=0.011). Individuals with osteoporosis had lower post-surgery body mass index (19.7 vs. 22.1, p=0.014).
Seventy-three individuals (50.3%) developed nutritional deficiencies during follow-up mainly iron (23.4%), vitamin B12 (20.6%) and vitamin D deficiencies (20.6%). Greater weight loss was associated with one or more nutritional deficiencies (28.1% drop from baseline vs. 22.1%, p<0.001). Dumping syndrome developed in 18 patients (12.4%).
Conclusions: PTG for
CDH1 carriers is associated with significant post-surgical morbidity including substantial weight loss, anatomic complications, bone density loss and nutritional deficiencies. Providers should include discussion and consideration of post-gastrectomy morbidity into the gastric cancer risk management decisions of
CDH1 carriers, as well as multi-disciplinary post-gastrectomy care.
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