Updates in Surgery

, Volume 70, Issue 2, pp 293–299 | Cite as

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

  • Daniela Zanotti
  • Gian Luca Baiocchi
  • Arianna Coniglio
  • Borzoueh Mohammadi
  • Silvia Ministrini
  • Muntzer Mughal
  • Guido A. M. Tiberio
  • Khaled Dawas
Original Article
Part of the following topical collections:
  1. Gastric Cancer Surgery


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.


Follow-up Gastric cancer Gastric surgery Surveillance 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, Forman D, Bray F (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403.
  2. 2.
    Kato H, Fukuchi M, Miyazaki T et al (2005) Classification of recurrent esophageal cancer after radical esophagectomy with two- or three-field lymphadenectomy. Anticancer Res 25:3461–3468PubMedGoogle Scholar
  3. 3.
    De Manzoni G, Pedrazzani C, Pasini F et al (2003) Pattern of recurrence after surgery in adenocarcinoma of the gastro-oesophageal junction. EJSO 29:506–510CrossRefPubMedGoogle Scholar
  4. 4.
    Toh Y, Oki E, Minami K, Okamura T (2010) Follow-up and recurrence after a curative esophagectomy for patients with esophageal cancer: the first indicators for recurrence and their prognostic values. Esophagus 7:37–43CrossRefGoogle Scholar
  5. 5.
    Lou F, Sima CS, Adusumilli PS et al (2013) Esophageal cancer recurrence: patterns and implications for surveillance. J Thorac Oncol 8(12):1558–1562CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kunisaki C, Makino H, Takagawa R et al (2008) Surgical outcomes in esophageal cancer patients with tumor recurrence after curative esophagectomy. J Gastrointest Surg 12:802–810CrossRefPubMedGoogle Scholar
  7. 7.
    Hur H, Song KY, Park CH, Jeon HM (2010) Follow-up strategy after curative resection of gastric cancer: a nationwide survey in Korea. Ann Surg Oncol 17:54–64CrossRefPubMedGoogle Scholar
  8. 8.
    Shiraishi N, Inomata M, Osawa N et al (2000) Early and late recurrence after gastrectomy for gastric carcinoma. Univariate and multivariate analyses. Cancer 89:255–261CrossRefPubMedGoogle Scholar
  9. 9.
    Baiocchi GL, Marrelli D, Verlato G et al (2014) Follow-up after gastrectomy for cancer: an appraisal of the Italian Research Group for Gastric Cancer. Ann Surg Oncol 21:2005–2011PubMedGoogle Scholar
  10. 10.
    Eom BW, Ryu KW, Lee JH et al (2011) Oncologic effectiveness of regular follow-up to detect recurrence after curative resection of gastric cancer. Ann Surg Oncol 18:358–364CrossRefPubMedGoogle Scholar
  11. 11.
    Kodera Y, Ito S, Yamamura Y, Mochizuki Y et al (2003) Follow-up surveillance for recurrence after curative gastric cancer surgery lacks survival benefit. Ann Surg Oncol 10:898–902CrossRefPubMedGoogle Scholar
  12. 12.
    Bennett JJ, Gonen M, D’Angelica M et al (2005) Is detection of asymptomatic recurrence after curative resection associated with improved survival in patients with gastric cancer? J Am Coll Surg 201:503–510CrossRefPubMedGoogle Scholar
  13. 13.
    Böhner H, Zimmer T, Hopfenmüller W, Berger G, Buhr HJ (2000) Detection and prognosis of recurrent gastric cancer—is routine follow-up after gastrectomy worthwhile? Hepatogastroenterology 47:1489–1494PubMedGoogle Scholar
  14. 14.
    Tan IT, So BY (2007) Value of intensive follow-up of patients after curative surgery for gastric carcinoma. J Surg Oncol 96:503–506CrossRefPubMedGoogle Scholar
  15. 15.
    Kim JH, Jang YJ, Park SS, Park SH, Mok YJ (2010) Benefit of post-operative surveillance for recurrence after curative resection for gastric cancer. J Gastrointest Surg 14:969–976CrossRefPubMedGoogle Scholar
  16. 16.
    Baiocchi GL, Kodera Y, Marrelli D, Pacelli F, Morgagni P, Roviello F, De Manzoni G (2014) Follow-up after gastrectomy for cancer: results of an international web round table. World J Gastroenterol 20(34):11966–11971. PMID: 25232232 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Allum WH, Blazeby JM, Griffin SM, Cunningham D et al (2011) Guidelines for the management of oesophageal and gastric cancer. Gut 60:1449–1472CrossRefPubMedGoogle Scholar
  18. 18.
    Stahl M, Oliveira J (2009) Esophageal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Supplement 4):vi32–vi33CrossRefGoogle Scholar
  19. 19.
    Oesophageal and GOJ tumours, guidelines, AIOM 2014. Accessed 11 Dec 2015
  20. 20.
    Waddell T, Verheij M, Allum W, Cunningham D et al (2013) Gastric cancer: ESMO–ESSO–ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Supplement 6):vi57–vi63PubMedGoogle Scholar
  21. 21.
    Gastric cancer, guidelines, AIOM 2014. Accessed 11 Dec 2015
  22. 22.
    Marrelli D, Morgagni P, de Manzoni G, Coniglio A et al (2005) Italian Research Group for Gastric Cancer (IRGGC): prediction of recurrence after radical surgery for gastric cancer. A scoring system obtained from a prospective multicentre study. Ann Surg 241:247–255CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Jeffrey M, Hickey BE, Hinder PN (2007) Follow up strategies for patients for non-metastatic colorectal cancer. Cochrane Database Syst Rev 1:CD002200Google Scholar
  24. 24.
    Rojas MP, Telaro E, Russo A et al (2005) Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev 1:CD001768Google Scholar
  25. 25.
    Moyes LH, Anderson JE, Forshaw MJ (2010) Proposed follow up programme after curative resection for lower third oesophageal cancer. WJSO 8:75Google Scholar
  26. 26.
    Baiocchi GL, Marrelli D, Verlato G, Morgagni P, Giacopuzzi S, Coniglio A, Marchet A, Rosa F, Capponi MG, Di Leo A, Saragoni L, Ansaloni L, Pacelli F, Nitti D, D’Ugo D, Roviello F, Tiberio GA, Giulini SM, De Manzoni G (2014) Follow-up after gastrectomy for cancer: an appraisal of the Italian Research Group for Gastric Cancer. Ann Surg Oncol 21(6):2005–2011. PubMedCrossRefGoogle Scholar
  27. 27.
    Villarreal-Garza C, Rojas-Flores M, Castro-Sanchez A et al (2011) Improved outcome in asymptomatic recurrence following curative surgery for gastric cancer. Med Oncol 28:973–980CrossRefPubMedGoogle Scholar
  28. 28.
    Tiberio GAM, Coniglio A, Marchet A et al (2009) Metachronous hepatic metastases from gastric carcinoma: a multicentric survey. Eur J Surg Oncol 35(5):486–491CrossRefPubMedGoogle Scholar
  29. 29.
    D’Ugo D, Baiocchi GL (2013) Rationale of oncological follow-up after gastrectomy for cancer—the consensus conference. Transl Gastrointest Cancer. CrossRefGoogle Scholar
  30. 30.
    Baiocchi GL, D’Ugo D, Coit D, Hardwick R, Kassab P, Nashimoto A, Marrelli D, Allum W, Berruti A, Chandramohan SM, Coburn N, Gonzàlez-Moreno S, Hoelscher A, Jansen E, Leja M, Mariette C, Meyer HJ, Mönig S, Morgagni P, Ott K, Preston S, Rha SY, Roviello F, Sano T, Sasako M, Shimada H, Schuhmacher C, So Bok-Yan J, Strong V, Yoshikawa T, Terashima M, Ter-Ovanesov M, Van der Velde C, Memo M, Castelli F, Pecorelli S, Detogni C, Kodera Y, de Manzoni G (2016) Follow-up after gastrectomy for cancer: the Charter Scaligero consensus conference. Gastric Cancer 19(1):15–20. CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  1. 1.Surgical Clinic, Department of Clinical and Experimental SciencesBrescia UniversityBresciaItaly
  2. 2.Gastrointestinal ServicesUniversity College HospitalLondonUK

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