Follow-Up Surveillance for Recurrence After Curative Gastric Cancer Surgery Lacks Survival Benefit

Kodera, Yasuhiro; Ito, Seiji; Yamamura, Yoshitaka; Mochizuki, Yoshinari; Fujiwara, Michitaka; Hibi, Kenji; Ito, Katsuki; Akiyama, Seiji; Nakao, Akimasa

doi:10.1245/aso.2003.12.009

Cited by 90 publications

(86 citation statements)

References 9 publications

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“…Detection of early recurrence may theoretically allow patients to receive palliative treatments such as chemotherapy, resulting in better outcomes. In the study by Kodera's group, detection of recurrent disease at an asymptomatic stage enabled a greater proportion of patients to be treated with chemotherapy (P = 0.076), possibly because performance status was better at the time of detection [8]. Clearly, biology is a dominant factor when assessing for recurrence in gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

Section: Surveillance Modalities (Appendix 3 Of the Esm)mentioning

confidence: 99%

“…All four studies [3,[6][7][8] reported a statistically significant improvement in postrecurrence survival for the asymptomatic groups. Overall survival (OS) was only reported by Kodera et al [8] and Tan et al [2]. The study by Kodera's group [8] included OS curves with an estimated median OS of 40 months for symptomatic patients and 51.7 months for asymptomatic patients (P = 0.19).…”

Section: Surveillance Modalities (Appendix 3 Of the Esm)mentioning

confidence: 99%

“…Overall survival (OS) was only reported by Kodera et al [8] and Tan et al [2]. The study by Kodera's group [8] included OS curves with an estimated median OS of 40 months for symptomatic patients and 51.7 months for asymptomatic patients (P = 0.19). Tan et al reported an average OS of 4.1 years (49.2 months) in the intensive follow-up group and 3.8 years (45.6 months) in the regular follow-up group (P = 0.46) [2].…”

Section: Surveillance Modalities (Appendix 3 Of the Esm)mentioning

confidence: 99%

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A systematic review of patient surveillance after curative gastrectomy for gastric cancer: a brief review

et al. 2012

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Background Complete resection of a gastric cancer and adjacent lymph nodes offers the only chance for cure of the disease. However, disease recurrence occurs in 22-51% of cases, and its prognosis is very poor. Many clinicians perform post-operative follow-up for these patients, although there is no consensus on the regimen, frequency of visits, mode of testing, or the rationale of a follow-up program. Purpose The objective of this systematic review was to identify the evidence for surveillance in patients with resected gastric cancer, specifically examining the interval of follow-up and the modalities utilized.Methods Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1st 1998 to December 1st 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. ResultsFive articles were selected. A total of 810 patients underwent post-operative follow-up. History and physical examination, hematological and chemistry profile, endoscopy (esophagogastroduodenoscopy [EGD]), and computed tomography (CT) were the most frequently employed modalities. CT detected the majority of recurrences in the included studies. The survival post-recurrence was significantly higher in the asymptomatic group compared with symptomatic group in three studies, but this may simply reflect lead-time bias. No differences in overall survival (OS) were found. Conclusion The included studies failed to show an improvement in OS with more intense surveillance. Further prospective studies are required to determine whether a subgroup of patients may benefit from more intensive follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Surveillance Modalities (Appendix 3 Of the Esm)mentioning

confidence: 99%

Section: Surveillance Modalities (Appendix 3 Of the Esm)mentioning

confidence: 99%

Section: Surveillance Modalities (Appendix 3 Of the Esm)mentioning

confidence: 99%

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A systematic review of patient surveillance after curative gastrectomy for gastric cancer: a brief review

et al. 2012

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“…Nevertheless, it remains unproven whether patients with asymptomatic recurrence have better survival outcomes than those with symptomatic recurrence. This is possibly because the previous studies analyzed peritoneal and nonperitoneal cases of recurrence together, despite the documented differences in treatment strategies and efficacies [10,11]. Indeed, nonperitoneal recurrence can be treated and potentially even cured by surgery if it is detected early enough, whereas chemotherapy is the only treatment option for peritoneal recurrence even if it is detected before symptom presentation [12].…”

Section: Introductionmentioning

confidence: 99%

Early detection of nonperitoneal recurrence may contribute to survival benefit after curative gastrectomy for gastric cancer

et al. 2016

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Background There is no evidence that strict follow-up using cross-sectional imaging after curative gastrectomy benefits survival; however, nonperitoneal recurrence detected early might be treated with additional surgery. The present study examined whether early detection of recurrence by imaging modalities could increase survival, particularly in patients with nonperitoneal recurrence. Methods We retrospectively analyzed 218 patients with recurrent gastric cancer after curative gastrectomy performed from 2002 to 2014. The patients were divided into an asymptomatic group (n = 117) and a symptomatic group (n = 101), according to the presence of symptoms at the time of recurrence, to compare clinicopathological characteristics and long-term survival. Results Peritoneal recurrence was less frequent in the asymptomatic group (22.2%) than in the symptomatic group (62.4%), the median time to recurrence was shorter (12.7 months vs 18.9 months; P \ 0.001), and the median survival time after recurrence was longer (18.7 months vs 7.5 months; P \ 0.001). In the asymptomatic group, 10 of 117 patients (8.5%) received additional curative surgery after recurrence. Median overall survival after gastrectomy was not significantly different between the groups (30.1 months for the asymptomatic group vs 30.0 months for the symptomatic group; P = 0.132); however, it was significantly longer among asymptomatic patients with nonperitoneal recurrence compared with symptomatic patients (35.9 months vs 24.0 months; P = 0.039). Conclusions The presence of symptoms at recurrence did not affect survival in patients with recurrent gastric cancer. However, detection of nonperitoneal recurrence before the appearance of symptoms may provide survival benefit. Therefore, regular follow-up, including use of imaging modalities, is recommended.

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Feasibility of Extended Postoperative Follow-Up in Patients With Gastric Cancer

Lee,

Kim,

Choi

2024

JAMA Surg

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ImportanceConventional research and guidelines on postgastrectomy follow-up for gastric cancer often restrict their focus to the first 5 years after surgery.ObjectiveTo evaluate the association of extended regular follow-up after 5 years postgastrectomy in patients with gastric cancer with overall and postrecurrence survival rates.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used Korean National Health Insurance claims data extracted between January 1, 2005, and December 31, 2014, with follow-up data examined until December 31, 2021. Patients without recurrence or other cancers at 5 years postgastrectomy were divided into 2 groups: those who had extended regular follow-up visits and those who did not. The data were analyzed between August 15 and November 15, 2023.ExposuresRegular follow-up vs irregular follow-up after 5 years postgastrectomy.Main Outcomes and MeasuresThe main outcome was whether extended regular follow-up after 5 years postgastrectomy was independently associated with overall and postrecurrence survival rates using Cox proportional hazards regression. Postrecurrence survival rates were also compared across different follow-up methods and intervals.ResultsA total of 40 468 patients with gastric cancer were included, with 14 294 in the regular follow-up group (mean [SD] age, 61.3 [11.7] years; 9669 male [67.8%]) and 26 174 in the irregular follow-up group (mean [SD] age, 58.1 [11.1] years; 18 007 male [68.8%]). Late recurrence or gastric remnant cancer (GRC) was identified in 3138 patients (7.8%), including 1610 of 40 468 patients (4.0%) between 5 and 10 years postgastrectomy and 1528 of 16 287 (9.4%) patients after 10 years postgastrectomy. Regular follow-up was associated with a significantly decreased overall mortality rate after 5 years postgastrectomy (from 49.4% to 36.9% in 15-year mortality rate; P &lt; .001), as well as significant improvement of postrecurrence survival rate after occurrence of late recurrence or GRC (from 32.7% to 71.1% in 5-year postrecurrence survival rate; P &lt; .001). Comparison of follow-up methods revealed that the combination of endoscopy and abdominopelvic computed tomography (CT) (only abdominopelvic CT in total gastrectomy subgroup) yielded the highest 5-year postrecurrence survival rate (endoscopy alone vs abdominopelvic CT alone vs a combination of both, 54.5% vs 47.1% vs 74.5%, respectively). A time interval of more than 2 years between previous endoscopy or abdominopelvic CT and late recurrence and GRC diagnosis was associated with a significantly reduced postrecurrence survival rate (hazard ratio, 1.72 [95% CI, 1.45-2.04] and 1.48 [95% CI, 1.25-1.75], respectively).Conclusions and RelevanceThese findings suggest that extended regular follow-up after 5 years postgastrectomy should be implemented clinically and that current practice and value of follow-up protocols in postoperative care of patients with gastric cancer be reconsidered.

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Follow-Up Surveillance for Recurrence After Curative Gastric Cancer Surgery Lacks Survival Benefit

Cited by 90 publications

References 9 publications

A systematic review of patient surveillance after curative gastrectomy for gastric cancer: a brief review

A systematic review of patient surveillance after curative gastrectomy for gastric cancer: a brief review

Early detection of nonperitoneal recurrence may contribute to survival benefit after curative gastrectomy for gastric cancer

Feasibility of Extended Postoperative Follow-Up in Patients With Gastric Cancer

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