Follow-up after surgery for gastric cancer: how to do it

There is no consensus on follow-up after gastric surgery for cancer, nor evidence that it improves outcomes. We investigated the impact of intensity of follow-up, comparing the regimens adopted by two centres, in Italy and in the UK. Patients who underwent surgery for gastric and junctional type-3 adenocarcinoma, between September 2009 and April 2013, at the Surgical Clinic, University of Brescia (Italy), and at the Department of Upper Gastrointestinal Surgery, University College London Hospital (UK), were identified. Patients' demographics, stage, recurrence rates, modality of detection and treatment were recorded. Overall survival and costs were compared between the two protocols. A total of 128 patients were included. Recurrence rates were similar (p = 0.349), with more than 70% diagnosed during regular follow-up appointments in both centres. At univariate and multivariate analysis, stage I and treatment of recurrence were associated with a better survival. Patients treated for recurrence at the Italian centre showed an almost significant better survival (p = 0.052). The intensive Italian surveillance protocol was associated with significant higher costs per year. Follow-up and early detection of recurrence did not affect survival in the analysed series, focused on periods in which chemotherapy was ineffective towards recurrence. However, intensive follow-up allowed a greater number of patients to receive a treatment for recurrence; this might prove useful in the next few years, when more effective chemotherapy combinations are expected to become available. The costs could be reduced by adopting a less intensive surveillance programme.