Follow-Up: The Evidence

Abstract

There is currently no consensus on the best strategy for the follow-up of patients who have undergone surgical treatment with curative intent for gastric cancer. The wide variation in recommendations for surveillance among international experts and hospital schedules clearly reflects a lack of an established body of evidence on this subject. Consequently, most of the international guidelines aimed at early detection of disease recurrence gloss over details concerning the mode, duration, and intensity of surveillance since they cannot be based on an acceptable grade of recommendation. Very few report anything other than the detection of recurrences or death as the primary endpoints, and, given the poor survival of patients with recurrent gastric cancer, the prognostic effect of early detection seems doubtful. In recent years, an increasing focus on evidence-based medicine, which has coincided with a growing concern about costs and efficiency in medicine, has caused a reevaluation of most surveillance practices. In this paper, we review and discuss the current body of evidence and follow-up practices after curative resection of gastric cancer.

Pattern of extragastric recurrence and the role of abdominal computed tomography in surveillance after endoscopic resection of early gastric cancer: Korean experiences

“…However, the role of CT after endoscopic resection is not clear. After surgical resection of gastric cancer, use of abdominal CT has not been shown to improve long-term survival [30,31,34]. In colorectal cancer, several randomized clinical trials and meta-analyses have reported that intensive follow-ups that included CT after curative resection increased the rate of curative surgery for recurrence compared with minimal follow-ups [35,36].…”

Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

“…A regular follow-up may allow investigation and treatment of symptoms, psychological support and early detection of recurrence, though there is no evidence that it improves survival outcomes [III, B] [98,99]. New strategies for patient follow-up are currently undergoing evaluation, including patient-led self-referral and services led by clinical nurse specialists [103].…”

Report from the 17th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Edmonton, Alberta; 11–12 September 2015

“…Very few trials report anything other than the detection of recurrence or death as their primary endpoints, and the prognostic effect of early detection seems doubtful, given the poor survival of patients with recurrent gc 11 . The limited studies available to date have not shown a survival benefit for the detection of asymptomatic recurrence compared with patient-reported symptomatic recurrence 12,13 . Furthermore, qol constitutes an important omission in the current literature.…”

“…Patient education and self-referral for abnormal symptoms are important. Periodic assessments are useful to address treatment-related complications, nutrition deficiencies (including vitamin B 12 and iron), and psychosocial issues. In patients with a subtotal gastrectomy, eradication of Helicobacter pylori is recommended.…”