Prophylactic Total Gastrectomy: Techniques

Prophylactic total gastrectomy (PTG) represents the treatment of choice for carriers of pathogenetic CDH1 mutations in the context of hereditary diffuse gastric cancer (HDGC) syndrome. PTG consists in a total gastrectomy: it could be performed both through open or minimally invasive surgery depending on the surgeon’s expertise, but the higher rate of postoperative complications reported after laparoscopic procedures should be taken into account especially in the specific context of a prophylactic surgery. The intra-operative control of resection margins with frozen section is mandatory to exclude residual of gastric mucosa. D1/D1+ is suggested but D2 dissection can be considered. Roux-en-Y reconstruction is preferred. Long-term follow-up shows a good quality of life after this type of surgery despite the weight loss.