The prognostic value of detecting symptomatic or asymptomatic recurrence in patients with gastric cancer after a curative gastrectomy

Bılıcı, Ahmet; Salman, Tarık; Ustaalioğlu, Bala Basak Oven; Şeker, Mesut; Aliustaoğlu, Mehmet; Gezen, Cem; Ünek, Tarkan; Yavuzer, Dilek; Ünlü, Mehtat; Gümüş, Mahmut; Yılmaz, Uğur

doi:10.1016/j.jss.2012.03.035

Cited by 21 publications

(21 citation statements)

References 10 publications

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“…Our results are consistent with those of previous studies, most of which analyzed a retrospective series and showed no survival benefit of early detection of recurrence, based on indirect evaluation of the effect of follow-up or no follow-up on survival by comparing survival between the presence or absence of symptoms at the time of recurrence [10,11,15,16]. In contrast, Tan and So [17] investigated the follow-up schedule itself for its effect on patient outcome by comparing long-term survival between patients who received intensive follow-up, which included computed tomography more than once every 12 months, and those who received regular follow-up.…”

Section: Discussionsupporting

confidence: 92%

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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Section: Discussionsupporting

confidence: 92%

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

et al. 2016

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“…It seems as if repeated follow-up examinations do not lead to discomfort but rather reassurance of the patients. Furthermore, the literature confirms that early asymptomatic diagnosis of recurrence is associated with improved prognosis [53,54].…”

Section: Discussionmentioning

confidence: 78%

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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“…Furthermore, asymptomatic patients had more benefit from re-resection and postrecurrence chemotherapy; at multivariate survival analysis the presence of symptoms was the only independent factor of poor survival, suggesting a more biologically aggressive disease in symptomatic patients. Bilici et al [51], in a study on 173 patients with recurrent gastric cancer, found that symptomatic recurrence is an important prognostic factor for postrecurrence survival and that the presence of symptoms may be considered a marker of biologic tumor aggressiveness, which is an important determinant of survival at the time of recurrence diagnosis during follow-up for gastric cancer.…”

Section: Evidence From Follow-up Studiesmentioning

confidence: 99%

Follow-Up: The Evidence

D’Ugo¹,

Biondi²,

Tufo³

et al. 2013

Dig Surg

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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.

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The prognostic value of detecting symptomatic or asymptomatic recurrence in patients with gastric cancer after a curative gastrectomy

Cited by 21 publications

References 10 publications

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

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

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

Follow-Up: The Evidence

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