AbstractBackground Prophylactic total gastrectomy (PTG) is indicated in patients with pathogenic germline mutations for hereditary diffuse gastric cancer (HDGC). In patients carrying CDH1 mutations with strong family history, cumulative lifetime risk of gastric cancer at eighty years of age was 70% for males and 56% for females. Safety of open and laparoscopic prophylactic gastrectomy have been described, but data supporting the safety of the robotic approach is lacking. The purpose of this study was to demonstrate the safety of robotic prophylactic total gastrectomy (rPTG) in patients with germline mutations for HDGC. Methods Retrospective analysis of individuals with germline mutations for HDGC who underwent rPTG from July 2018 to January 2025 at a single institution. Results Twenty patients with germline mutations for HDGC (CDH1: 19, CTNNA1: 1) underwent rPTG. Median age was 44 years-old (36-54), there were 12 females and 8 males, median ASA was 2 (2-3), and preoperative BMI was 29 (25.8-34.7). Median operative time was 272min (245-351), and estimated blood loss was 50mL (45-100). Most patients had T1a disease (No cancer: 4, Tis: 2, T1a: 14), all lymph nodes were negative, median harvest was 18 (14-23), and margins were negative in all patients. Average hospital stay was 5 days (4-6). Acute major morbidity (Clavien-Dindo grade ≥3) was 15% (3/20). There were no mortalities. Conclusions Robotic prophylactic total gastrectomy in patients with germline mutations for hereditary diffuse gastric cancer is a safe procedure which is comparable to outcomes of published open and laparoscopic approaches in the literature.
Gazivoda et al. (Fri,) studied this question.