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Prophylactic Laparoscopic Total Gastrectomy with Jejunal Pouch Reconstruction in Patients Carrying a CDH1 Germline Mutation.

Haverkamp L, van der Sluis PC, Ausems MG, van der Horst S, Siersema PD, Ruurda JP, Offerhaus GJ, van Hillegersberg R - J. Gastrointest. Surg. (2015)

Bottom Line: The latter eight patients did not develop anastomotic leakage.Multiple foci of intramucosal diffuse gastric signet ring cell carcinoma were found in the resection specimen of 9/11 (82 %) patients.In 82 % of patients, foci of intramucosal diffuse gastric signet ring cell carcinoma in the resection specimen were found.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. leonie.haverkamp@gmail.com.

ABSTRACT

Background: For patients with an identified germline E-cadherin-1 (CDH1) mutation, prophylactic gastrectomy is the treatment of choice to eliminate the high risk of developing diffuse gastric cancer. Laparoscopic total gastrectomy with jejunal pouch reconstruction is a novel approach that may be especially suitable in these patients.

Methods: Patients with a germline CDH1 mutation who underwent prophylactic laparoscopic total gastrectomy with jejunal pouch were included in our prospective database.

Results: A total of 11 patients with a median age of 40 (22-61) years were included. The average operative time was 4:26 ± 0:49 h and the average blood loss was 219 ± 155 ml. Median length of hospital stay was 10 (7-27) days. In two patients, an esophagojejunal anastomotic leakage occurred (grade 4). The leakages were seen in patient numbers 2 and 3, which may be a result of a learning curve. The latter eight patients did not develop anastomotic leakage. Pulmonary complications occurred in one patient with atelectasis and in one patient with pneumonia (grade 2). The 60-day mortality rate was 0 %. Multiple foci of intramucosal diffuse gastric signet ring cell carcinoma were found in the resection specimen of 9/11 (82 %) patients. All 11/11 (100 %) resections were microscopically radical.

Conclusions: Prophylactic laparoscopic total gastrectomy with jejunal pouch reconstruction in patients with a CDH1 germline mutation is feasible and safe. In 82 % of patients, foci of intramucosal diffuse gastric signet ring cell carcinoma in the resection specimen were found.

No MeSH data available.


Related in: MedlinePlus

Removal of the gastric resection specimen through the Endopath DextrusTM access port
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Fig3: Removal of the gastric resection specimen through the Endopath DextrusTM access port

Mentions: A horizontal incision in the left upper abdomen, with sparing of the rectus muscle, was created through the left 12-mm port, and an Endopath DextrusTM (Ethicon Endosurgery, Southington, CT, USA) access port was inserted. The resection specimen was removed through this port and was sent in for frozen section evaluation (Fig. 3). The first bowel loop was divided with an Endo-GIA stapler, and the Roux-en-Y reconstruction was completed with an isoperistaltic side-to-side jejunal-jejunal anastomosis manually created with a PDS 3.0 continuous suture. The distal jejunum was used to create a “J”-shaped pouch (Fig. 4), using a 100-mm linear stapler (Covidien, Norwalk, CT, USA). An antecolic 10-cm esophageal (pouch)-jejunal (EJ) anastomosis was created with the Orvil circular stapler (Fig. 5). The proximal and distal esophageal-jejunal donuts were pathologically examined. The blind jejunal loop was stapled. Distal to this anastomosis, a feeding jejunostomy was inserted.Fig. 3


Prophylactic Laparoscopic Total Gastrectomy with Jejunal Pouch Reconstruction in Patients Carrying a CDH1 Germline Mutation.

Haverkamp L, van der Sluis PC, Ausems MG, van der Horst S, Siersema PD, Ruurda JP, Offerhaus GJ, van Hillegersberg R - J. Gastrointest. Surg. (2015)

Removal of the gastric resection specimen through the Endopath DextrusTM access port
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4641153&req=5

Fig3: Removal of the gastric resection specimen through the Endopath DextrusTM access port
Mentions: A horizontal incision in the left upper abdomen, with sparing of the rectus muscle, was created through the left 12-mm port, and an Endopath DextrusTM (Ethicon Endosurgery, Southington, CT, USA) access port was inserted. The resection specimen was removed through this port and was sent in for frozen section evaluation (Fig. 3). The first bowel loop was divided with an Endo-GIA stapler, and the Roux-en-Y reconstruction was completed with an isoperistaltic side-to-side jejunal-jejunal anastomosis manually created with a PDS 3.0 continuous suture. The distal jejunum was used to create a “J”-shaped pouch (Fig. 4), using a 100-mm linear stapler (Covidien, Norwalk, CT, USA). An antecolic 10-cm esophageal (pouch)-jejunal (EJ) anastomosis was created with the Orvil circular stapler (Fig. 5). The proximal and distal esophageal-jejunal donuts were pathologically examined. The blind jejunal loop was stapled. Distal to this anastomosis, a feeding jejunostomy was inserted.Fig. 3

Bottom Line: The latter eight patients did not develop anastomotic leakage.Multiple foci of intramucosal diffuse gastric signet ring cell carcinoma were found in the resection specimen of 9/11 (82 %) patients.In 82 % of patients, foci of intramucosal diffuse gastric signet ring cell carcinoma in the resection specimen were found.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. leonie.haverkamp@gmail.com.

ABSTRACT

Background: For patients with an identified germline E-cadherin-1 (CDH1) mutation, prophylactic gastrectomy is the treatment of choice to eliminate the high risk of developing diffuse gastric cancer. Laparoscopic total gastrectomy with jejunal pouch reconstruction is a novel approach that may be especially suitable in these patients.

Methods: Patients with a germline CDH1 mutation who underwent prophylactic laparoscopic total gastrectomy with jejunal pouch were included in our prospective database.

Results: A total of 11 patients with a median age of 40 (22-61) years were included. The average operative time was 4:26 ± 0:49 h and the average blood loss was 219 ± 155 ml. Median length of hospital stay was 10 (7-27) days. In two patients, an esophagojejunal anastomotic leakage occurred (grade 4). The leakages were seen in patient numbers 2 and 3, which may be a result of a learning curve. The latter eight patients did not develop anastomotic leakage. Pulmonary complications occurred in one patient with atelectasis and in one patient with pneumonia (grade 2). The 60-day mortality rate was 0 %. Multiple foci of intramucosal diffuse gastric signet ring cell carcinoma were found in the resection specimen of 9/11 (82 %) patients. All 11/11 (100 %) resections were microscopically radical.

Conclusions: Prophylactic laparoscopic total gastrectomy with jejunal pouch reconstruction in patients with a CDH1 germline mutation is feasible and safe. In 82 % of patients, foci of intramucosal diffuse gastric signet ring cell carcinoma in the resection specimen were found.

No MeSH data available.


Related in: MedlinePlus