[Proper follow-up schedule after curative gastric surgery].
Although the prognosis of gastric cancer after R0 resection is considered to be comparatively satisfactory , some patients experience cancer recurrence according to their stage. Recurrence patterns after curative gastrectomy and follow-up surveillance were studied. An analysis was done in about 307 (8.0%) patients with recurrences of 3,861 primary gastric cancers who underwent R0 resection with sufficient lymph node dissection from 1990 to 2006.


RESULTS
The median age was 64 years old, and there were 211 men and 96 women. The recurrence rates were hematological 41%, peritoneal 33%, and remote lymph nodal 24%, though peritoneal recurrence was most frequent in references. There were many peritoneal and remote lymph nodal recurrences in undifferentiated adenocarcinomas, and hematological recurrences in differentiated adenocarcinomas. In pT1, hematological recurrences were 83% and lymph nodal recurrences were 17%, even after 5 years. In more than half, remnant stomach cancers were found, and these cases underwent surgery again 5 years after primary surgery. The frequency of peritoneal recurrence was increased remarkably in pT3 and pT4. The proportion of recurrence was 77% within 2 years and 91% within 3 years, respectively. There was no difference between lymph nodal, hematological and peritoneal recurrence in survival time after primary surgery and even after recurrence. Referring to these results, follow-up surveillance plans for early and advanced gastric cancers were made. Surveillance was to be continued for 10 years after surgery in the early cancers and 5 years after surgery in the advanced cancers. Moreover, a mass surveyor complete medical checkup was recommended at 5 years after surgery. A standard follow-up plan will be made soon for early and advanced gastric cancer patients, respectively, though it is not necessarily the same in several institutes. There is no consensus yet regarding the intensive follow-up plan after R0 resection, because the evidence of efficacy is not yet confirmed. In conclusion, an intensive scientific investigation of the follow-up plan is required to determine wether or not there are survival benefits.
Nashimoto
Atsushi
A
Division of Gastric Surgery, Niigata Cancer Center Hospital.
Yabusaki
Hiroshi
H
Nakagawa
Satoru
S
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*