Robotic-assisted total gastrectomy in a teenager with CDH1 mutation: a case report
Bibliographic record
Abstract
CDH1 mutation is a rare autosomal dominant mutation. Individuals with this mutation have a lifetime risk of up to 70 % for developing diffuse gastric cancer, often at a young age, and many undergo prophylactic total gastrectomies. We present the case of a teenage girl with a known CDH1 mutation, identified through family screening. Her family history was significant for diffuse gastric carcinoma, with multiple relatives, including her mother, having previously undergone total gastrectomies due to malignancy. On her first surveillance gastroscopy at age 13, multiple small foci of signet ring cells were discovered despite the absence of clinical symptoms. In collaboration with our adult thoracic surgical team, we conducted a 6-h robotic-assisted total gastrectomy, with Roux-en-Y reconstruction using 4 robotic ports (one of which was an umbilical 10 mm camera port) and one laparoscopic assistant port. Both the esophagojejunal and jejunojejunal anastomoses were create with a robotic stapler. The procedure was successful, and the patient had a favorable postoperative course. The patient resumed gradual enteral feeds post-op day 1 and was discharged home on post-op day 8 tolerating her regular diet. Final pathology confirmed the presence of scattered signet ring cell foci, with negative margins and lymph nodes. The patient continues to do well at one year follow-up, with ongoing nutritional and psychological support. This case is unique as, to the best of our knowledge, it represents one of only a handful of robotic-assisted total gastrectomies reported in pediatric patients worldwide. Robotic-assisted surgery seems to be a feasible option for teenagers who require a prophylactic total gastrectomy due to a CDH1 mutation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".