[Prophylactic gastric surgery].
A premalignant condition with high risk of gastric cancer is the basis for prophylactic gastric surgery. The germline mutation carrier in the E-cadherin gene has a lifetime risk of 70-80% for diffuse-type gastric cancer, and high-grade intraepithelial neoplasia has a 60-70% gastric cancer risk. Other premalignant conditions such as HNPCC syndrome (5% gastric cancer) and low-grade intraepithelial neoplasia (10% risk) are moderate risk factors for developing gastric cancer. They do not justify prophylactic surgery, but surveillance is required. In case high-grade intraepithelial neoplasia or early gastric cancer is detected, an option is extended radicality with total gastrectomy instead of subtotal gastric resection. Positive family history and early-onset of gastric cancer are risk factors to consider when discussing prophylactic gastrectomy or extended radicality.
Vogelsang
H
H
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München. vogelsang@nt1.chir.med.tu-muenchen.de
Ott
K
K
Mehler
J
J
Keller
G
G
Siewert
J R
JR
D000293:Adolescent; D000328:Adult; D015820:Cadherins / Q000235:genetics; D002278:Carcinoma in Situ / Q000235:genetics / Q000601:surgery*; D002648:Child; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000235:genetics / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D018095:Germ-Line Mutation; D006801:Humans; D008297:Male; D010375:Pedigree; D011230:Precancerous Conditions / Q000601:surgery*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000235:genetics / Q000517:prevention & control / Q000601:surgery*; D013997:Time Factors
D015820:Cadherins