Prophylactic laparoscopic total gastrectomy for gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS): the first report in Asia

Matsumoto, Chihiro; Iwatsuki, Masaaki; Iwagami, Shiro; Morinaga, Takeshi; Yamashita, Kohei; Nakamura, Kenichi; Eto, Kojiro; Kurashige, Junji; Baba, Yoshifumi; Miyamoto, Yuji; Yoshida, Naoya; Komohara, Yoshihiro; Baba, Hideo

doi:10.1007/s10120-021-01253-x

Cited by 9 publications

(16 citation statements)

References 15 publications

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“…GAPPS was first reported by Worthly et al in 2012 [ 1 ]. Since then, there have been an increasing number of reports on GAPPS [ 5 – 9 ]; however, the clinical course, malignant transformation, and prognosis of GAPPS remain unclear. The prognosis of GAPPS depends on the malignancy of the FGPs.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding prophylactic TG for GAPPS, patients who fulfill the diagnostic criteria for GAPPS and those with FGPs progressing to dysplasia should undergo prophylactic TG [ 14 ]. Recently, this has been performed in Asian countries [ 5 ]. Prophylactic gastrectomy is associated with the risk of postoperative complications, such as infections, dumping syndrome, and weight loss.…”

Section: Discussionmentioning

confidence: 99%

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Four cases of gastric adenocarcinoma and proximal polyposis of the stomach treated by robotic total gastrectomy

et al. 2022

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Background Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) is a rare disease and characterized by a unique point mutation in the promoter 1B region of the adenomatous polyposis coli (APC) gene. There are two aims in surgery for GAPPS; the first is prophylactic gastrectomy, and the second is excising concurrent cancer. We performed robotic total gastrectomy (RTG) for four cases of GAPPS. Case presentation Case 1 was a woman in her 40 s whose sister had died from gastric cancer. Mutational analysis revealed mutation of APC exon 1B. We performed prophylactic gastrectomy. Case 2 was a woman in her 30 s who had a mutation of APC exon 1B, and preoperative biopsy revealed suspected adenocarcinoma. Case 3 was a woman in her 40 s who was diagnosed with gastric cancer with multiple polyps in the stomach and a mutation of APC exon 1B. Case 4 was a woman in her 20 s in whom biopsy revealed low-grade dysplasia of a raised lesion. She had a mutation in APC exon 1B. We performed RTG with D1 + lymphadenectomy in all patients, and there were no intraoperative complications. Conclusions Patients with GAPPS are mainly followed regularly with repeat biopsy, and tumors are detected in an early stage. As the safety of robotic surgery for the early gastric cancer is reported, RTG is an option for these patients. This is the first report of RTG for GAPPS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Four cases of gastric adenocarcinoma and proximal polyposis of the stomach treated by robotic total gastrectomy

et al. 2022

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“…10 In our case, the rapid progression to GC with distant metastasis was observed in a brief period of 10 months. 14 The micropapillary component was observed in the biopsy specimens, although the proportion was small. Furthermore, sampling in cases of polyposis, which includes FGP with different degrees of dysplasia, is challenging.…”

Section: Endoscopic Surveillancementioning

confidence: 93%

“…Table 1 summarizes the cases of therapeutic and prophylactic gastrectomy for GAPPS. 5,8,10,14,[16][17][18][19][20][21][22] On the other hand, if not already developed with GC, prophylactic total gastrectomy for GAPPS must be considered very carefully, with caution, and with a fully individualized approach. Repak et al 10 stated that patients who fulfill the original GAPPS criteria and those with FGP progression to dysplasia should be tested for genetic mutations so that prophylactic gastrectomy can be performed appropriately.…”

Section: Prophylactic Gastrectomymentioning

confidence: 99%

“…Table 1 summarized the cases who underwent prophylactic total gastrectomy for GAPPS. 8,14,16,[19][20][21][22] Based on these previous reports, the algorithm for GAPPS family members with or without mutation of the 1B promoter of the APC gene is proposed. 15 In early reports, the death of a family member was the main reason for surgery without a genetic test, but in recent reports, preoperative genetic tests are performed to diagnose GAPPS, and prophylactic total gastrectomy has been performed.…”

Section: Prophylactic Gastrectomymentioning

confidence: 99%

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The comprehensive review of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) from diagnosis and treatment

Iwatsuki

Matsumoto

Mimori

et al. 2023

Annals of Gastroent Surgery

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Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) was first proposed by Wothley et al. in 2012 as a rare familial gastric cancer syndrome associated with an autosomal dominant form of inheritance. GAPPS is characterized by gastric basal gland polyposis from the hilum to the body of the stomach. Li et al. in 2016 showed that the cause of the disease is a point mutation in the promotor 1B region of the APC gene, and genetic testing was used to confirm the diagnosis. If the patient has already developed gastric cancer, treatment should be based on the usual treatment for gastric cancer. If no distant metastases exist, a good prognosis can be expected by performing a total gastrectomy. On the other hand, patients with distant metastasis have a poor prognosis. In the case of dysplasia, prophylactic total gastrectomy is recommended, but because it is highly invasive and postoperative postgastrectomy syndrome must be considered, the decision should be made with careful consideration of the patient's background. Therefore, there are no guidelines for screening for GAPPS, the timing of prophylactic total gastrectomy, or methods of endoscopic surveillance. Because GAPPS is a rare disease, its natural history is still unclear. Further case series are needed to elucidate the molecular biology and clinicopathological features of GAPPS and to establish clinical management, including diagnosis, treatment, and surveillance. In this review, we provide an overview of GAPPS, its clinical management, and its problems, which will be useful for the treatment of GAPPS.

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Gastric fundic gland polyposis and cancer development after eradication of Helicobacter pylori in patient with gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS)

Okamoto,

Kawaguchi,

Kagemoto

et al. 2024

Gastric Cancer

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Prophylactic laparoscopic total gastrectomy for gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS): the first report in Asia

Cited by 9 publications

References 15 publications

Four cases of gastric adenocarcinoma and proximal polyposis of the stomach treated by robotic total gastrectomy

Four cases of gastric adenocarcinoma and proximal polyposis of the stomach treated by robotic total gastrectomy

The comprehensive review of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) from diagnosis and treatment

Gastric fundic gland polyposis and cancer development after eradication of Helicobacter pylori in patient with gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS)

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