Follow-up after surgery for gastric cancer: how to do it
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There is no consensus on follow-up after gastric surgery for cancer, nor evidence that it improves outcomes. We investigated the impact of intensity of follow-up, comparing the regimens adopted by two centres, in Italy and in the UK. Patients who underwent surgery for gastric and junctional type-3 adenocarcinoma, between September 2009 and April 2013, at the Surgical Clinic, University of Brescia (Italy), and at the Department of Upper Gastrointestinal Surgery, University College London Hospital (UK), were identified. Patients’ demographics, stage, recurrence rates, modality of detection and treatment were recorded. Overall survival and costs were compared between the two protocols. A total of 128 patients were included. Recurrence rates were similar (p = 0.349), with more than 70% diagnosed during regular follow-up appointments in both centres. At univariate and multivariate analysis, stage I and treatment of recurrence were associated with a better survival. Patients treated for recurrence at the Italian centre showed an almost significant better survival (p = 0.052). The intensive Italian surveillance protocol was associated with significant higher costs per year. Follow-up and early detection of recurrence did not affect survival in the analysed series, focused on periods in which chemotherapy was ineffective towards recurrence. However, intensive follow-up allowed a greater number of patients to receive a treatment for recurrence; this might prove useful in the next few years, when more effective chemotherapy combinations are expected to become available. The costs could be reduced by adopting a less intensive surveillance programme.
KeywordsFollow-up Gastric cancer Gastric surgery Surveillance
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Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
This article does not contain any studies with human participants or animals performed by any of the authors.
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- 1.Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, Forman D, Bray F (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403. https://doi.org/10.1016/j.ejca.2012.12.027
- 16.Baiocchi GL, Kodera Y, Marrelli D, Pacelli F, Morgagni P, Roviello F, De Manzoni G (2014) Follow-up after gastrectomy for cancer: results of an international web round table. World J Gastroenterol 20(34):11966–11971. https://doi.org/10.3748/wjg.v20.i34.11966 PMID: 25232232 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Oesophageal and GOJ tumours, guidelines, AIOM 2014. http://www.aiom.it. Accessed 11 Dec 2015
- 21.Gastric cancer, guidelines, AIOM 2014. http://www.aiom.it. Accessed 11 Dec 2015
- 22.Marrelli D, Morgagni P, de Manzoni G, Coniglio A et al (2005) Italian Research Group for Gastric Cancer (IRGGC): prediction of recurrence after radical surgery for gastric cancer. A scoring system obtained from a prospective multicentre study. Ann Surg 241:247–255CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Jeffrey M, Hickey BE, Hinder PN (2007) Follow up strategies for patients for non-metastatic colorectal cancer. Cochrane Database Syst Rev 1:CD002200Google Scholar
- 24.Rojas MP, Telaro E, Russo A et al (2005) Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev 1:CD001768Google Scholar
- 25.Moyes LH, Anderson JE, Forshaw MJ (2010) Proposed follow up programme after curative resection for lower third oesophageal cancer. WJSO 8:75Google Scholar
- 26.Baiocchi GL, Marrelli D, Verlato G, Morgagni P, Giacopuzzi S, Coniglio A, Marchet A, Rosa F, Capponi MG, Di Leo A, Saragoni L, Ansaloni L, Pacelli F, Nitti D, D’Ugo D, Roviello F, Tiberio GA, Giulini SM, De Manzoni G (2014) Follow-up after gastrectomy for cancer: an appraisal of the Italian Research Group for Gastric Cancer. Ann Surg Oncol 21(6):2005–2011. https://doi.org/10.1245/s10434-014-3534-8 PubMedGoogle Scholar
- 29.D’Ugo D, Baiocchi GL (2013) Rationale of oncological follow-up after gastrectomy for cancer—the consensus conference. Transl Gastrointest Cancer. https://doi.org/10.3978/j.issn.2224-4778.2013.06.01 Google Scholar
- 30.Baiocchi GL, D’Ugo D, Coit D, Hardwick R, Kassab P, Nashimoto A, Marrelli D, Allum W, Berruti A, Chandramohan SM, Coburn N, Gonzàlez-Moreno S, Hoelscher A, Jansen E, Leja M, Mariette C, Meyer HJ, Mönig S, Morgagni P, Ott K, Preston S, Rha SY, Roviello F, Sano T, Sasako M, Shimada H, Schuhmacher C, So Bok-Yan J, Strong V, Yoshikawa T, Terashima M, Ter-Ovanesov M, Van der Velde C, Memo M, Castelli F, Pecorelli S, Detogni C, Kodera Y, de Manzoni G (2016) Follow-up after gastrectomy for cancer: the Charter Scaligero consensus conference. Gastric Cancer 19(1):15–20. https://doi.org/10.1007/s10120-015-0513-0 CrossRefPubMedGoogle Scholar