Indications for total gastrectomy in CDH1 mutation carriers and outcomes of risk-reducing minimally invasive and open gastrectomies Journal Article


Authors: Vos, E. L.; Salo-Mullen, E. E.; Tang, L. H.; Schattner, M.; Yoon, S. S.; Gerdes, H.; Markowitz, A. J.; Mandelker, D.; Janjigian, Y.; Offitt, K.; Coit, D. G.; Stadler, Z. K.; Strong, V. E.
Article Title: Indications for total gastrectomy in CDH1 mutation carriers and outcomes of risk-reducing minimally invasive and open gastrectomies
Abstract: Importance: CDH1 variants are increasingly identified on commercially available multigene panel tests, calling for data to inform counseling of individuals without a family history of gastric cancer. Objectives: To assess association between CDH1 variant pathogenicity or family history of gastric or lobular breast cancer and identification of signet ring cell cancer and to describe outcomes of risk-reducing minimally invasive and open total gastrectomy. Design, Setting, and Participants: This cohort study was performed from January 1, 2006, to January 1, 2020, in 181 patients with CDH1 germline variants from a single institution. Interventions: Genetic counseling, esophagogastroduodenoscopy, and possible total gastrectomy. Main Outcomes and Measures: CDH1 variant classification, family cancer history, findings of signet ring cell carcinoma at esophagogastroduodenoscopy and surgery, postoperative events and weight changes, and follow-up. Results: Of 181 individuals with CDH1 germline variants (mean [SD] age at time of testing, 44 [15] years; 126 [70%] female), 165 harbored a pathogenic or likely pathogenic variant. Of these patients, 101 underwent open (n = 58) or minimally invasive (n = 43) total gastrectomy. Anastomotic leaks that required drainage were infrequent (n = 3), and median long-term weight loss was 20% (interquartile range [IQR], 10%-23%). In those undergoing minimally invasive operations, more lymph nodes were retrieved (median, 28 [IQR, 20-34] vs 15 [IQR, 9-19]; P <.001) and the hospital stay was 1 day shorter (median, 6 [IQR, 5-7] vs 7 [IQR, 6-7] days; P =.04). Signet ring cell cancer was identified in the surgical specimens of 85 of 95 patients (89%) with a family history of gastric cancer and 4 of 6 patients (67%) who lacked a family history. Among the latter 6 patients, 4 had a personal or family history of lobular breast cancer, including 2 with signet ring cell cancer. Of the 16 patients with pathogenic or likely pathogenic CDH1 variants who presented with locally advanced or metastatic gastric cancer, 3 (19%) had no family history of gastric cancer or personal or family history of lobular breast cancer. Conclusions and Relevance: Total gastrectomy may be warranted for patients with pathogenic or likely pathogenic CDH1 variants and a family history of gastric or lobular breast cancer and may be appropriate for those without a family history. A minimally invasive approach is feasible and may be preferred for selected patients. © 2020 American Medical Association. All rights reserved.
Journal Title: JAMA Surgery
Volume: 155
Issue: 11
ISSN: 2168-6254
Publisher: American Medical Association  
Date Published: 2020-11-01
Start Page: 1050
End Page: 1057
Language: English
DOI: 10.1001/jamasurg.2020.3356
PUBMED: 32997132
PROVIDER: scopus
PMCID: PMC7527942
DOI/URL:
Notes: Article -- Export Date: 4 January 2021 -- Source: Scopus
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MSK Authors
  1. Sam Yoon
    108 Yoon
  2. Kenneth Offit
    790 Offit
  3. Hans Gerdes
    176 Gerdes
  4. Arnold J Markowitz
    139 Markowitz
  5. Zsofia Kinga Stadler
    393 Stadler
  6. Yelena Yuriy Janjigian
    400 Janjigian
  7. Laura Hong Tang
    448 Tang
  8. Vivian Strong
    268 Strong
  9. Daniel Coit
    542 Coit
  10. Mark Schattner
    169 Schattner
  11. Diana Lauren Mandelker
    181 Mandelker
  12. Elvira Lise Vos
    26 Vos