Abstract
About two-thirds of patients with advanced gastric cancer treated by R0 resection develop tumor relapse during the follow-up, and most of them will die from the disease. The main patterns of dissemination are peritoneal, hematogenous, and locoregional, and their incidence differs according to multiple clinical, surgical, and pathological factors. The main purpose of follow-up is to diagnose tumor relapse as early as possible. An ideal follow-up program is one that is individualized according to the predicted risk, timing, and site of recurrence. However, the real clinical utility of these programs is affected by the low chance of cure for recurrent gastric cancer. Surgical treatment has a limited role and is indicated only in a few cases of resectable locoregional recurrences, isolated liver metastases, or limited peritoneal carcinomatosis. Currently, the prevention of recurrence is probably more important than its early detection. A correct surgical procedure and the selection of pre-, peri- or postoperative systemic and/or locoregional treatments could improve the prognosis of gastric cancer patients. The Italian Research Group for Gastric cancer has developed an individualized follow-up program based on the risk of recurrence and patients’ compliance with follow-up. Three different schedules (mild, moderate, or intensive) are proposed
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Yoo CH, Noh SH, Shin DW et al (2000) Recurrence following curative resection for gastric carcinoma. Br J Surg 87:236–242
Kodera Y, Ito S, Yamamura Y et al (2003) Follow-up surveillance for recurrence after curative gastric cancer surgery lacks survival benefit. Ann Surg Oncol 10:898–902
D’Angelica M, Gonen M, Brennan MF et al (2004) Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg 240:808–816
Marrelli D, De Stefano A, de Manzoni G et al (2005) Prediction of recurrence after radical surgery for gastric cancer: a scoring system obtained from a prospective multicenter study. Ann Surg 241:247–255
Lehnert T, Rudek B, Buhl K et al (2002) Surgical therapy for loco-regional recurrence and distant metastasis of gastric cancer. Eur J Surg Oncol 28:455–461
Roviello F, Caruso S, Marrelli D et al (2011) Treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: state of the art and future developments. Surg Oncol 20:38–54
Marrelli D, Roviello F, De Stefano A et al (2004) Risk factors for liver metastases after curative surgical procedures for gastric cancer: a prospective study of 208 patients treated with surgical resection. J Am Coll Surg 198:51–58
Kakeji Y, Morita M, Maehara Y (2010) Strategies for treating liver metastasis from gastric cancer. Surg Today 40:287–294
Whiting J, Sano T, Saka M et al (2006) Follow-up of gastric cancer: a review. Gastric Cancer 9:74–81
Macdonald JS, Smalley SR, Benedetti J et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725–730
Songun I, Putter H, Kranenbarg EM et al (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449
Japanese Gastric Cancer Association Registration Committee (2006) Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer 9:51–66
Sasako M, Sano T, Yamamoto S et al (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359:453–462
Dikken JL, Jansen EP, Cats A et al (2010) Impact of the extent of surgery and postoperative chemoradiotherapy on recurrence patterns in gastric cancer. J Clin Oncol 28:2430–2436
Marrelli D, Roviello F, de Manzoni G et al (2002) Different patterns of recurrence in gastric cancer depending on Lauren’s histological type: longitudinal study. World J Surg 26:1160–1165
Roviello F, Marrelli D, de Manzoni G et al (2003) Prospective study of peritoneal recurrence after curative surgery for gastric cancer. Br J Surg 90:1113–1119
Mezhir JJ, Shah MA, Jacks LM et al (2010) Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Ann Surg Oncol 17:3173–3180
de Manzoni G, Verlato G, Di Leo A et al (2006) Peritoneal cytology does not increase the prognostic information provided by TNM in gastric cancer. World J Surg 30:579–584
Badgwell B, Cormier JN, Xing Y et al (2009) Attempted salvage resection for recurrent gastric or gastroesophageal cancer. Ann Surg Oncol 16:42–50
Morgagni P, Marfisi C, Gardini A et al (2009) Subtotal gastrectomy as treatment for distal multifocal early gastric cancer. J Gastrointest Surg 13:2239–2244
Marrelli D, Mazzei MA, Pedrazzani C et al (2011) High Accuracy of Multislices Computed Tomography (MSCT) for Para-Aortic Lymph Node Metastases from Gastric Cancer:A Prospective Single-Center Study. Ann Surg Oncol (In press)
Shimada H, Okazumi S, Koyama M et al (2011) Clinical utility of (18)F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature. Gastric Cancer (In press)
Marrelli D, Pinto E, De Stefano A et al (2001) Clinical utility of CEA, CA 19-9, and CA 72-4 in the follow-up of patients with resectable gastric cancer. Am J Surg 181:16–19
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 201:503–510
Hur H, Song KY, Park CH (2010) Follow-up strategy after curative resection of gastric cancer: a nationwide survey in Korea. Ann Surg Oncol 17:54–64
Jensen EH, Tuttle TM (2007) Preoperative staging and postoperative surveillance for gastric cancer. Surg Oncol Clin N Am 16:329–342
Nunobe S, Hiki N, Ohyama S et al (2011) Outcome of surgical treatment for patients with locoregional recurrence of gastric cancer. Langenbecks Arch Surg 396:161–166
Tiberio GA, Coniglio A, Marchet A et al (2009) Metachronous hepatic metastases from gastric carcinoma: a multicentric survey. Eur J Surg Oncol 35:486–491
Glehen O, Gilly FN, Arvieux C et al (2010) Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol 17:2370–2377
Yan TD, Black D, Sugarbaker PH et al (2007) A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann Surg Oncol 14:2702–2713
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Marrelli, D., Caruso, S., Roviello, F. (2012). Follow-up and Treatment of Recurrence. In: de Manzoni, G., Roviello, F., Siquini, W. (eds) Surgery in the Multimodal Management of Gastric Cancer. Springer, Milano. https://doi.org/10.1007/978-88-470-2318-5_25
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DOI: https://doi.org/10.1007/978-88-470-2318-5_25
Publisher Name: Springer, Milano
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