Predictive Role of Endoscopic Surveillance after Total Gastrectomy with R0 Resection for Gastric Cancer

Abstract

Background Endoscopic surveillance after total gastrectomy (TG) for gastric cancer is routinely performed to detect tumor recurrence and postoperative adverse events. However, the reports on the clinical benefits of endoscopic surveillance are ambiguous. We investigated the clinical benefit of endoscopic surveillance after TG for gastric cancer. Methods We analyzed 848 patients who underwent TG with R0 resection for gastric cancer between 2011 and 2012 (380 early gastric cancer and 468 advanced gastric cancer) and underwent regular postoperative surveillance with endoscopy and abdominopelvic computed tomography (CT) with contrast. Results Median follow-up periods were 58 months for both endoscopy (range, 3–96) and abdominopelvic CT (range, 1–96). Tumor recurrence occurred in 167 patients (19.7%), of whom seven (4.2%) were locoregional recurrences in the peri-anastomotic area (n = 5) or regional gastric lymph nodes (n = 2). Whereas the peri-anastomotic recurrences were detected by both endoscopy and abdominopelvic CT, regional lymph node recurrences were only detected by abdominopelvic CT. Out of the 23 events of postoperative adverse events, the majority (87%) were detected by radiologic examinations; three events of benign strictures in the anastomotic site were detected only by endoscopy. Conclusion Endoscopic surveillance did not have a significant role in detecting locoregional tumor recurrence and postoperative adverse events after TG with R0 resection for gastric cancer. Routine endoscopic surveillance after TG may be considered optional and performed according to the capacities of each clinical setting.

Comparison of adjuvant capecitabine plus oxaliplatin (CAPOX) versus S-1 after gastrectomy: a population-based cohort study using a nationwide claims database

“…The corresponding rates were 65.4% and 71.7% after adjuvant S-1 in the ACTS-GC trial 18 . In real-world data, on the other hand, the recurrence rate after gastrectomy was found to be 19.7-20.5%, which was much lower than the results of clinical trials 19,20 . In our study, the 5-year recurrence rates were 13.9% and 21.6% in Arm S and C, respectively, which were slightly lower than or similar to those from real-world data.…”

Comparison of adjuvant capecitabine plus oxaliplatin (CAPOX) versus S-1 in patients with gastric cancer after gastrectomy: A nationwide cohort study based on the National Health Insurance Service (NHIS) database in Korea

“…The corresponding rates were 65.4% and 71.7% after adjuvant S-1 in the ACTS-GC trial [21]. In real-world data, on the other hand, the recurrence rate after gastrectomy was found to be 19.7-20.5%, which was much lower than the results of clinical trials [22,23]. In our study, the ve-year recurrence rates were 13.9% and 21.6% in Arm S and C, respectively, which were slightly lower than or similar to those from real-world data.…”