Follow-up after curative resection for gastric cancer: Is it time to tailor it?

Abstract

There is still no consensus on the follow-up frequency and regimen after curative resection for gastric cancer. Moreover, controversy exists regarding the utility of follow-up in improving survival, and the recommendations of experts and societies vary considerably. The main reason to establish surveillance programs is to diagnose tumor recurrence or metachronous cancers early and to thereby provide prompt treatment and prolong survival. In the setting of gastric malignancies, other reasons have been put forth: (1) the detection of adverse effects of a previous surgery, such as malnutrition or digestive sequelae; (2) the collection of data; and (3) the identification of psychological and/or social problems and provision of appropriate support to the patients. No randomized controlled trials on the role of follow-up after curative resection of gastric carcinoma have been published. Herein, the primary retrospective series and systematic reviews on this subject are analyzed and discussed. Furthermore, the guidelines from international and national scientific societies are discussed. Follow-up is recommended by the majority of institutions; however, there is no real evidence that follow-up can improve long-term survival rates. Several studies have demonstrated that it is possible to stratify patients submitted to curative gastrectomy into different classes according to the risk of recurrence. Furthermore, promising studies have identified several molecular markers that are related to the risk of relapse and to prognosis. Based on these premises, a promising strategy will be to tailor follow-up in relation to the patient and tumor characteristics, molecular marker status, and individual risk of recurrence.

White blood cell and cell-free DNA analyses for detection of residual disease in gastric cancer

“…A major challenge after multimodal curative treatment for resectable gastric cancer is identifying patients with microscopic residual disease at high risk of recurrence after surgery [1][2][3][4] . Currently available imaging techniques and traditional blood biomarkers to capture minimal residual disease (MRD) state after surgery have poor sensitivity and do not play a role in clinical practice 5 . Histopathological assessment of the effects of neoadjuvant chemotherapy on resection specimens has become an important tool to provide prognostic information [6][7][8] .…”

Besonderheiten in der Nachsorge von gastrointestinalen Tumoren

“…Insgesamt rezidivieren 30-40 % der Magenkarzinome nach kurativ intendierter Therapie, davon über 90 % innerhalb der ersten drei Jahre [1, [10][11][12]. Die häufigste Rezidivlokalisation ist peritoneal, gefolgt von hepatischen Metastasen und lokoregionären Rezidiven.…”

“…Durch Verlaufsendoskopien können die Läsionen häufiger und mit besserer Prognose erneut lokal behandelt werden. Nach chirurgischer Resektion liegt die Rate an Magenstumpfkarzinomen bei 1-7 %, wobei der Rezidivzeitpunkt sehr variabel ist [10]. [10].…”

Tumor-specific genetic aberrations in cell-free DNA of gastroesophageal cancer patients

“…Although it has yet to be proven that organized follow-up increases the survival of patients, the general consensus is that some sort of follow-up should be performed [91]. The type and time of surveillance differ between countries but may include endoscopy (with biopsy when relevant), CT scans, biomarker analysis or simply patient-doctor consultations.…”