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The Impact of Prophylactic Total Gastrectomy on Health-Related Quality of Life: A Prospective Cohort Study

Worster, Elizabeth*; Liu, Xinxue PhD*; Richardson, Susan RGN; Hardwick, Richard H. MD; Dwerryhouse, Sarah MSc; Caldas, Carlos MD§; Fitzgerald, Rebecca C. MD*

doi: 10.1097/SLA.0000000000000446
Original Articles

Background: The advice to individuals with identified CDH1 mutations is generally to undertake prophylactic total gastrectomy (PTG). This study evaluated the effect of PTG on health-related quality of life (HRQL) in asymptomatic individuals with identified CDH1 mutations at high risk for gastric cancer.

Methods: Individuals with hereditary diffuse gastric cancer (HDGC) were recruited to a prospective, multicenter UK study. Questionnaires, including the European Organization for Research and Treatment for Cancer core Quality-of-Life Questionnaire (EORTC QLQ C30); the gastric cancer specific module (EORTC QLQ STO22); and the 36-item short form health survey version 2.0, were completed before and at regular intervals after surgery.

Results: Sixty individuals fulfilled HDGC criteria; 38 (63%) had a CDH1 mutation and 32 (53%) underwent PTG. At baseline, there was no significant difference in mental health depending on CDH1 mutation status and treatment preference. Physical functioning reduced in the first month after surgery but recovered to baseline by 12 months. Similarly mental functioning reduced in the first month after surgery but recovered by 3 to 9 months. However, specific symptoms were identified, such as diarrhoea (70%), fatigue (63%), discomfort when eating (81%), reflux (63%), eating restrictions (45%), and body image (44%), which persisted after PTG.

Conclusions: Patients contemplating prophylactic gastrectomy can be reassured about the long-term HRQL outcomes, but some residual symptoms require adjustment.

In this prospective cohort study of patients with hereditary diffuse gastric cancer, we found that prophylactic gastrectomy initially causes significant morbidity in terms of physical and mental well-being but, generally, this is recovered by around 1 year postsurgery. Patients contemplating prophylactic gastrectomy can be reassured about the long-term health-related quality-of-life outcomes.

*MRC Cancer Unit, University of Cambridge, UK

Department of Oncology, Addenbrooke's Hospital, Cambridge, UK

Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK

§Cancer Research UK Cambridge Institute, Cambridge, UK.

Reprints: Rebecca C. Fitzgerald, MD, MRC Cancer Unit, University of Cambridge, Hills Rd, Cambridge CB2 0XZ, UK. E-mail:

Disclosure: The authors have nothing to declare. The research was supported by a Cancer Research UK grant to Carlos Caldas and Medical Research Council Programmatic funding to Rebecca Fitzgerald. Elizabeth Worster was an undergraduate summer student working with Rebecca Fitzgerald. Infrastructure support is received from the National Institute for Health Research (NIHR)–funded Biomedical Research Centre and the Cambridge Experimental Medicine Centre.

© 2014 by Lippincott Williams & Wilkins.