Impact of the Surveillance Interval on the Survival of Patients Who Undergo Curative Surgery for Gastric Cancer

Park, Chan Hyuk; Park, Jun Chul; Lee, Hyuk-Joon; Shin, Sung Kwan; Lee, Sang Kil; Cheong, Jae Ho; Hyung, Woo Jin; Lee, Yong Chan; Noh, Sung Hoon; Kim, Choong Bae

doi:10.1245/s10434-015-4866-8

Cited by 21 publications

(17 citation statements)

References 30 publications

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“…The lack of survival benefit from intensive follow-up in our entire patient collective can be explained by more advanced (y)pT and (y)pN categories in the SFU group. Patients with more advanced tumor stages are more likely to be subjected to intensive follow-up than patients with early stage disease [43,44,46]. We believe that this selection bias could explain why other series failed to show a beneficial effect of intensive postoperative surveillance on survival [43][44][45].…”

Section: Discussionmentioning

confidence: 94%

“…Patients with more advanced tumor stages are more likely to be subjected to intensive follow-up than patients with early stage disease [43,44,46]. We believe that this selection bias could explain why other series failed to show a beneficial effect of intensive postoperative surveillance on survival [43][44][45]. Besides, even general practitioners or other outpatient physicians seem to frequently arrange cross-sectional imaging during follow-up for patients with esophagogastric cancer.…”

Section: Discussionmentioning

confidence: 98%

“…Data addressing this problem are limited, retrospective, and of varying quality. Studies comparing intensive vs. less intensive or symptom-driven surveillance could not detect a difference in overall survival, but as there was significant heterogeneity between groups with respect to treatment modalities, age, and tumor stage [43][44][45], no valid conclusion can be drawn from these results.…”

Section: Introductionmentioning

confidence: 97%

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Postoperative follow-up programs improve survival in curatively resected gastric and junctional cancer patients: a propensity score matched analysis

et al. 2017

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After PSM, standardized follow-up by a specialized center significantly improved OS. Cross-sectional imaging and treatment of recurrence were associated with better outcome. Regular follow-up by cross-sectional imaging especially during the first 3 years should be recommended by national guidelines, since early detection might help select patients for treatment of recurrence and even resection in few designated cases.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 97%

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Postoperative follow-up programs improve survival in curatively resected gastric and junctional cancer patients: a propensity score matched analysis

et al. 2017

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“…Park et al[49] in 2016 reviewed the clinical data of 376 patients with intra-abdominal recurrence after curative gastrectomy. These patients were classified according to the surveillance interval.…”

Section: What Is the Evidence?mentioning

confidence: 99%

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

Aurello¹,

Petrucciani²,

Antolino³

et al. 2017

WJG

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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.

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“…They reported no difference in the length of survival, although recurrences were detected earlier in the intensive follow-up group [17]. Park et al [18] also reported the benefit of suitable surveillance intervals for overall survival after curative surgery for gastric cancer, concluding that once a year is sufficient for follow-up imaging studies and that shortening the surveillance interval is not necessary for improving survival and is not recommended. Differently from the present study, none of these previous studies separated patients into those with peritoneal recurrence and those with nonperitoneal recurrence when analyzing survival outcome and symptoms at the time of recurrence.…”

Section: Discussionmentioning

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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Impact of the Surveillance Interval on the Survival of Patients Who Undergo Curative Surgery for Gastric Cancer

Cited by 21 publications

References 30 publications

Postoperative follow-up programs improve survival in curatively resected gastric and junctional cancer patients: a propensity score matched analysis

Postoperative follow-up programs improve survival in curatively resected gastric and junctional cancer patients: a propensity score matched analysis

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

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

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