Prophylactic Total Gastrectomy: a Prospective Cohort Study of Long-Term Impact on Quality of Life

Abstract

Background

Hereditary diffuse gastric cancer (HDGC) syndrome is caused by germline mutations in the CDH1 gene and carries a lifetime gastric cancer risk of approximately 70 % in men and 56 % in women. Current consensus guidelines recommend that people of age ≥20 who harbor a CDH1 mutation undergo prophylactic total gastrectomy (PTG). However, the decision to proceed with a major visceral resection for prophylactic reasons may be difficult, especially since long-term outcomes are not well defined. We examined the decision-making process, physical symptoms, and psychosocial outcomes in adults who underwent PTG.

Methods

Participants completed pre- and post-operative questionnaires that included standardized measures of health-related quality of life (HRQOL), body image, psychological distress, regret, and decisional conflict. Those who declined surgery completed a questionnaire that measured decisional conflict and explored reasons for their choice.

Results

Forty of fifty (80 %) questionnaires distributed to 18 individuals were completed. In the 13 patients who underwent PTG, global HRQOL tended to decrease immediately post-operatively, climb to baseline by 6–12 months, then decrease again at 24 months. Body image and level of psychological distress remained relatively stable, and most patients expressed little decisional conflict or regret. All five individuals who declined surgery did so for practical reasons and would consider surgery in the future.

Conclusions

While most patients do not experience negative psychosocial consequences following PTG, mild physical symptoms persist and may affect long-term HRQOL. The present study emphasizes the need for long-term follow-up of this unique population of survivors.

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Authors’ Contribution

All authors have reviewed and approved the final manuscript. JM, MA, MJE, and CJS were involved in the conception/design of the study and JM, MA, and AP were involved in data acquisition/analysis. JM and CJS drafted the manuscript.

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Corresponding author

Correspondence to Carol J. Swallow.

Ethics declarations

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding Sources

Not applicable.

Additional information

Jennifer Muir MD MSc and Melyssa Aronson MS contributed equally to this work.

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Muir, J., Aronson, M., Esplen, M. et al. Prophylactic Total Gastrectomy: a Prospective Cohort Study of Long-Term Impact on Quality of Life. J Gastrointest Surg 20, 1950–1958 (2016). https://doi.org/10.1007/s11605-016-3287-8

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Keywords

  • Stomach neoplasms
  • Gastrectomy
  • Quality of life
  • Body image
  • Decision-making