Annals of Surgical Oncology

, Volume 21, Issue 6, pp 2005–2011 | Cite as

Follow-Up After Gastrectomy for Cancer: An Appraisal of the Italian Research Group for Gastric Cancer

  • Gian Luca Baiocchi
  • Daniele Marrelli
  • Giuseppe Verlato
  • Paolo Morgagni
  • Simone Giacopuzzi
  • Arianna Coniglio
  • Alberto Marchet
  • Fausto Rosa
  • Michela Giulii Capponi
  • Alberto Di Leo
  • Luca Saragoni
  • Luca Ansaloni
  • Fabio Pacelli
  • Donato Nitti
  • Domenico D’Ugo
  • Franco Roviello
  • Guido A. M. Tiberio
  • Stefano M. Giulini
  • Giovanni De Manzoni
Gastrointestinal Oncology

Abstract

Background

The Italian Research Group for Gastric Cancer supports the practice of follow-up after radical surgery for gastric cancer.

Methods

This multicenter, retrospective study (1998–2009) included patients with T1-4N0-3M0 gastric cancer who had undergone D2 gastrectomy and lymphadenectomy, with at least 15 lymph nodes examined, and who had developed recurrent disease. Timing and site of recurrence were correlated to the actual scheduled follow-up timing and modalities.

Results

From eight centers, 814 patients with recurrent cancer and over 1,754 (46.4 %) patients undergoing gastrectomy were investigated (median follow-up 31 months). The most frequent sites of recurrence were local/regional lymph nodes (35.4 %), liver (24.3 %), peritoneum (30.3 %), lung (10.4 %) and intraluminal (7.5 %). Ninety-four percent of the recurrences were diagnosed within 2 years and 98 % within 3 years. Thoracoabdominal computed tomography (CT) scan and (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (18-FDG-PET) detected more than 90 % of recurrences, abdominal ultrasound detected 70 % and tumor markers detected 40 %, while <10 % were identified by physical examination, chest X-ray, and upper gastrointestinal endoscopy. Twenty-six percent of patients with recurrence were treated, but only 3.2 % were treated with potentially radical intent.

Conclusion

Oncological follow-up after radical surgery for gastric cancer should be focused in the first 3 years, and based mainly on thoracoabdominal CT scan and 18-FDG-PET.

Keywords

Gastric Cancer Overall Survival Early Gastric Cancer Gastrointestinal Endoscopy Gastric Cancer Case 

Supplementary material

10434_2014_3534_MOESM1_ESM.doc (24 kb)
Supplementary material 1 (DOC 24 kb)
10434_2014_3534_MOESM2_ESM.ppt (258 kb)
Supplementary material 2 (PPT 258 kb)

References

  1. 1.
    Roviello F, Marrelli D, de Manzoni G, et al. Prospective study of peritoneal recurrence after curative surgery for gastric cancer. Br J Surg. 2003;90:1113–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Shiraishi N, Inomata M, Osawa N, Yasuda K, Adachi Y, Kitano S. Early and late recurrence after gastrectomy for gastric carcinoma: univariate and multivariate analyses. Cancer. 2000;89:255–61.PubMedCrossRefGoogle Scholar
  3. 3.
    Schwarz RE, Zagala-Nevarez K. Recurrence patterns after radical gastrectomy for gastric cancer: prognostic factors and implications for postoperative adjuvant therapy. Ann Surg Oncol. 2002;9:394–400.PubMedCrossRefGoogle Scholar
  4. 4.
    Baiocchi GL, Tiberio G, Minicozzi A, et al. A multicentric western analysis of prognostic factors in advanced, node-negative gastric cancer patients. Ann Surg. 2010;252:70–3.PubMedCrossRefGoogle Scholar
  5. 5.
    Marrelli D, Roviello F, de Manzoni G, et al. Different pattern of recurrence in gastric cancer depending on Lauren’s histological type: a longitudinal study. World J Surg. 2002;26:1160–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Bohner H, Zimmer T, Hopfenmüller W, Berger G, Buhr HJ. Detection and prognosis of recurrent gastric cancer; is routine follow-up after gastrectomy worthwhile? Hepatogastroenterology. 2000;47:1489–94.PubMedGoogle Scholar
  7. 7.
    Eom BW, Ryu KW, Lee JH, et al. Oncologic effectiveness of regular follow-up to detect recurrence after curative resection of gastric cancer. Ann Surg Oncol. 2009;18:358–64.CrossRefGoogle Scholar
  8. 8.
    Kodera Y, Ito S, Yamamura Y, Mochizuki Y, et al. Follow-up surveillance for recurrence after curative gastric cancer surgery lacks survival benefit. Ann Surg Oncol. 2003;10:898–902.PubMedCrossRefGoogle Scholar
  9. 9.
    Tan IT, So BY. Value of intensive follow-up of patients after curative surgery for gastric carcinoma. J Surg Oncol. 2007;96:503–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Villarreal-Garza C, Rojas-Flores M, Castro-Sánchez A, Villa AR, García-Aceituno L, León-Rodríguez E. Improved outcome in asymptomatic recurrence following curative surgery for gastric cancer. Med Oncol. 2011;28:973–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Whiting J, Sano T, Saka M, Fukagawa T, Katai H, Sasako M. Follow-up of gastric cancer: a review. Gastric Cancer. 2006;9:74–81.PubMedCrossRefGoogle Scholar
  12. 12.
    Verlato G, Roviello F, Marchet A, et al. Indexes of surgical quality in gastric cancer surgery: experience of an Italian network. Ann Surg Oncol. 2009;16:594–602.PubMedCrossRefGoogle Scholar
  13. 13.
    Marrelli D, De Stefano A, de Manzoni G, Morgagni P, Di Leo A, Roviello F. Prediction of recurrence after radical surgery for gastric cancer: a scoring system obtained from a prospective multicenter study. Ann Surg. 2005;241:247–255.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Marrelli D, Caruso S, Roviello F. Follow-up and treatment of recurrence. In: de Manzoni G, Roviello F, Siquini W, editors. Surgery in the multimodal management of gastric cancer. Milan: Springer; 2012.Google Scholar
  15. 15.
    Bennett JJ, Gonen M, D’Angelica M, Jaques DP, Brennan MF, Coit DG. Is detection of asymptomatic recurrence after curative resection associated with improved survival in patients with gastric cancer? J Am Coll Surg. 2005;201:503–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Kim JH, Jang YJ, Park SS, Park SH, Mok YJ. Benefit of post-operative surveillance for recurrence after curative resection for gastric cancer. J Gastrointest Surg. 2010;14:969–76.PubMedCrossRefGoogle Scholar
  17. 17.
    Hur H, Song KY, Park CH, Jeon HM. Follow-up strategy after curative resection of gastric cancer: a nationwide survey in Korea. Ann Surg Oncol. 2010;17:54–64.PubMedCrossRefGoogle Scholar
  18. 18.
    Moon YW, Jeung HC, Rha SY, et al. Changing patterns of prognosticators during 15-year follow-up of advanced gastric cancer after radical gastrectomy and adjuvant chemotherapy: a 15-year follow-up study at a single Korean institute. Ann Surg Oncol. 2007;14:2730–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Nashimoto A, Yabusaki H, Nakagawa S. Proper follow-up schedule after curative gastric surgery [in Japanese]. Gan To Kagaku Ryoho. 2009;36:1402–7.PubMedGoogle Scholar
  20. 20.
    Yamamoto M, Yamanaka T, Baba H, Kakeji Y, Maehara Y. The postoperative recurrence and the occurrence of second primary carcinomas in patients with early gastric carcinoma. J Surg Oncol. 2008;97:231–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Sano T, Sasako M, Kinoshita T, Maruyama K. Recurrence of early gastric cancer: follow-up of 1475 patients and review of the Japanese literature. Cancer. 1993;72:3174–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Nashimoto A, Yabusaki H, Nakagawa S. Evaluation and problems of follow-up surveillance after curative gastric cancer surgery. Nihon Geka Gakkai Zasshi. 2007;108:120–4.PubMedGoogle Scholar
  23. 23.
    Lee SY, Lee JH, Hwang NC, et al. The role of follow-up endoscopy after total gastrectomy for gastric cancer. Eur J Surg Oncol. 2005;31:265–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Morgagni P, Marfisi C, Gardini A, et al. Subtotal gastrectomy as treatment for distal multifocal early gastric cancer. J Gastrointest Surg. 2009;13:2239–44.PubMedCrossRefGoogle Scholar
  25. 25.
    Marrelli D, Pinto E, De Stefano A, Farnetani M, Garosi L, Roviello F. Clinical utility of CEA, CA 19-9, and CA 72-4 in the follow-up of patients with resectable gastric cancer. Am J Surg. 2001;181:16–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Ohtsuka T, Nakafusa Y, Sato S, Kitajima Y, Tanaka M, Miyazaki K. Different roles of tumor marker monitoring after curative resections of gastric and colorectal cancers. Dig Dis Sci. 2008;53:1537–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Takahashi Y, Takeuchi T, Sakamoto J, et al; Tumor Marker Committee. The usefulness of CEA and/or CA19-9 in monitoring for recurrence in gastric cancer patients: a prospective clinical study. Gastric Cancer. 2003;6:142–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Tas F, Faruk Aykan N, Aydiner A, Yasasever V, Topuz E. Measurement of serum CA 19-9 may be more valuable than CEA in prediction of recurrence in patients with gastric cancer. Am J Clin Oncol. 2001;24:148–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII. Washington, DC: National Academy of Sciences; 2005.Google Scholar
  30. 30.
    International Commission on Radiological Protection. The 2007 recommendations of the International Commission on Radiological Protection. New York: International Commission on Radiological Protection; 2007. ICRP publication 103.Google Scholar
  31. 31.
    Yoo SY, Kim KW, Han JK, Kim AY, Lee HJ, Choi BI. Helical CT of postoperative patients with gastric carcinoma: value in evaluating surgical complications and tumor recurrence. Abdom Imaging. 2003;28:617–23.PubMedCrossRefGoogle Scholar
  32. 32.
    Jadvar H, Tatlidil R, Garcia AA, Conti PS. Evaluation of recurrent gastric malignancy with [F-18]-FDG positron emission tomography. Clin Radiol. 2003;58:215–21.PubMedCrossRefGoogle Scholar
  33. 33.
    Sun L, Su XH, Guan YS, et al. Clinical role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in post-operative follow up of gastric cancer: initial results. World J Gastroenterol. 2008;14:4627–32.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Takeyoshi I, Ohwada S, Ogawa T, et al. The resection of non-hepatic intraabdominal recurrence of gastric cancer. Hepatogastroenterology. 2000;47:1479–81.PubMedGoogle Scholar
  35. 35.
    Sakamoto Y, Ohyama S, Yamamoto J, et al. Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients. Surgery. 2003;133:507–11.PubMedCrossRefGoogle Scholar
  36. 36.
    Okano K, Maeba T, Ishimura K, et al. Hepatic resection for metastatic tumors from gastric cancer. Ann Surg. 2002;235:86–91.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Tiberio GA, Coniglio A, Marchet A, et al. Metachronous hepatic metastases from gastric carcinoma: a multicentric survey. Eur J Surg Oncol. 2009;35:486–91.PubMedCrossRefGoogle Scholar
  38. 38.
    de Liano AD, Yarnoz C, Aguilar R, Artieda C, Ortiz H. Surgical treatment of recurrent gastric cancer. Gastric Cancer. 2008;11:10–4.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Gian Luca Baiocchi
    • 1
    • 10
  • Daniele Marrelli
    • 2
  • Giuseppe Verlato
    • 3
  • Paolo Morgagni
    • 4
  • Simone Giacopuzzi
    • 5
  • Arianna Coniglio
    • 1
  • Alberto Marchet
    • 6
  • Fausto Rosa
    • 7
  • Michela Giulii Capponi
    • 8
  • Alberto Di Leo
    • 9
  • Luca Saragoni
    • 4
  • Luca Ansaloni
    • 8
  • Fabio Pacelli
    • 7
  • Donato Nitti
    • 6
  • Domenico D’Ugo
    • 7
  • Franco Roviello
    • 2
  • Guido A. M. Tiberio
    • 1
  • Stefano M. Giulini
    • 1
  • Giovanni De Manzoni
    • 5
  1. 1.Department of Clinical and Experimental Sciences, Surgical ClinicBrescia UniversityBresciaItaly
  2. 2.Department of Human Pathology and Oncology, Surgical OncologySiena UniversitySienaItaly
  3. 3.Unit of Epidemiology and Medical StatisticsUniversity of VeronaVeronaItaly
  4. 4.Department of General SurgeryMorgagni-Pierantoni HospitalForlìItaly
  5. 5.1st Department of General Surgery, Borgo Trento HospitalUniversity of VeronaVeronaItaly
  6. 6.II Surgical ClinicPadova UniversityPaduaItaly
  7. 7.Department of Surgical SciencesCatholic UniversityRomeItaly
  8. 8.General Surgery IOspedali RiunitiBergamoItaly
  9. 9.General Surgery Unit, Arco HospitalAPSS of TrentoTrentoItaly
  10. 10.Department of Medical and Surgical Sciences, Surgical ClinicBrescia UniversityBresciaItaly

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