Risk-Reducing Oncology Surgery: Discussing Short- and Long-Term Effects With Patients

By: Maurie Markman, MD

From: medscape.com

Hello. I’m Dr Maurie Markman, from City of Hope. I’ll be briefly discussing a very interesting paper, which recently appeared in the Journal of Clinical Oncology, entitled, “Costs of Cancer Prevention: Physical and Psychosocial Sequelae of Risk-Reducing Total Gastrectomy.”

Clearly, the oncology community is very familiar with risk-reducing surgery. Certainly, based on the experience in individuals with BRCA mutations for breast cancer and ovarian cancer, the benefits of that surgery are very well documented. We also have experience with individuals who have familial adenomatous polyposis and the potential benefits of reducing the risk for colon cancer with colectomy.

This is a different surgery, though. Here, we’re talking about total gastrectomy, and obviously, for different germline mutations. This was the CDH1 variant. This study included a total of 126 individuals who underwent such surgery from October 2017 to December 2021. It was very interesting that the postoperative major morbidity, as one would have hoped and expected, was quite low in this population, at 5.6%.

However, if one looks at the longer-term effects, almost all patients in this analysis lost weight. At 2 years, 94% of the individuals had at least one chronic condition. One quarter of the patients had a change in occupation, and several other social factors were noted. The quality of life for the individuals went down after surgery, but very importantly, according to this analysis, between 6 and 12 months, the overall quality of life returned to what was described at baseline.

I think the most important part of this analysis is, in fact, the information that is gathered, both the short-term and long-term outcomes, and the fact that this is information that needs to be shared with prospective patients who are considering the surgery.

Now, the risk for cancer is a critically important point. Here, we know that a very large percentage of these individuals with these germline variants are at risk of developing this gastric cancer during their lifetime.

What about the negative effects? What about the short-term and long-term effects? This has to be included in the discussion with the patients. The information collected in this particular analysis, and other analyses that hopefully will be done in the future, are vitally important as part of this conversation.

Again, I encourage those of you who are involved in this area, thinking about this area, or who have patients you need to counsel in this area, that this is an important paper and an important discussion. Thank you for your attention.