E. Strong (ed.). Gastric cancer. Principles and practice. Springer (2015)
Cancer surveillance after treatment is a complex issue in oncology as cancer treatments continue to evolve and patients are surviving longer. The choice of a follow-up program is a challenging topic and it should theoretically take into account survival and quality-of-life issues as well as the burden of surveillance tests, and their financial costs.
The potential value of a surveillance program in patients who have undergone cancer surgery is to detect recurrences in the early and asymptomatic period, to identify complications associated with surgery and to collect outcome data. Early detection of cancer recurrence may be associated with improved survival because it may provide an opportunity for treatment to be initiated while the patient’s condition is sufficiently stable to receive effective therapy.
Postoperative follow-up schedule is recommended for nearly all cancers in international guidelines, even if the value of postoperative surveillance remains controversial [1, 2].
In colorectal and breast cancers several randomized controlled trials and meta-analyses have demonstrated an overall survival advantage associated with detection [3, 4].
Gastric cancer is one of the most frequent malignancies and the second leading cause of cancer deaths worldwide with 989,600 new cases and 738,000 deaths in 2008, accounting for 8% of the total cases and 10% of total deaths due to cancer .
Recurrence is the most important factor associated with death even after potentially curative gastrectomy. Over two-thirds of recurrences occur in the first 3 years following surgery and fewer than 10% occur after 5 years; given the poor survival of patients with recurrent gastric cancer only palliative therapy is generally possible [6, 8].
Most clinicians perform postoperative surveillance for their gastric cancer patients during the first 3 years after surgery. However, there is no consensus on the most appropriate regimen and frequency of follow-up after curative surgery .
It must also be said that patients could be possibly reassured from regular follow-up, although psychological benefit of surveillance is debatable.
There is a wide variation in recommendations for surveillance among experts. In recent years an increasing focus on evidence-based medicine that has coincided with growing concern about costs and efficiency in medicine has caused a reevaluation of surveillance practices.
To date, all of the recommendations on surveillance are based on low-level evidence or no evidence at all given the complete lack of randomized controlled trials on this peculiar subject. Very few report anything other than the detection of recurrences or death as the primary endpoints, and given the poor survival of patients with an ascertained recurrent gastric cancer, the prognostic effect of early detection seems doubtful .
The objective of this chapter is to review the literature about the efficacy of follow-up protocols and investigations after gastrectomy for cancer.
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