Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2017; 23(19): 3379-3387
Published online May 21, 2017. doi: 10.3748/wjg.v23.i19.3379
Follow-up after curative resection for gastric cancer: Is it time to tailor it?
Paolo Aurello, Niccolò Petrucciani, Laura Antolino, Diego Giulitti, Francesco D'Angelo, Giovanni Ramacciato
Paolo Aurello, Niccolò Petrucciani, Laura Antolino, Diego Giulitti, Francesco D'Angelo, Giovanni Ramacciato, Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, 00189 Rome, Italy
Niccolò Petrucciani, Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, 06200 Nice, France
Author contributions: Aurello P, Petrucciani N, D'Angelo F and Ramacciato G made substantial contributions to conception and design; Aurello P, Petrucciani N, Antolino L, Giulitti D and Ramacciato G contributed to acquisition of data, analysis and interpretation of data; Aurello P, Petrucciani N, Antolino L and Giulitti D participated in drafting the article; all authors participated in revising it critically for important intellectual content, and gave final approval of the version to be submitted.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest in publishing this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Niccolò Petrucciani, MD, Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, via di Grottarossa 1035-1039, 00189 Rome, Italy. nicpetrucciani@hotmail.it
Telephone: +33-663-130995 Fax: +33-663-775322
Received: January 26, 2017
Peer-review started: February 3, 2017
First decision: February 23, 2017
Revised: March 22, 2017
Accepted: April 21, 2017
Article in press: April 21, 2017
Published online: May 21, 2017
Processing time: 114 Days and 6.5 Hours
Abstract

There is still no consensus on the follow-up frequency and regimen after curative resection for gastric cancer. Moreover, controversy exists regarding the utility of follow-up in improving survival, and the recommendations of experts and societies vary considerably. The main reason to establish surveillance programs is to diagnose tumor recurrence or metachronous cancers early and to thereby provide prompt treatment and prolong survival. In the setting of gastric malignancies, other reasons have been put forth: (1) the detection of adverse effects of a previous surgery, such as malnutrition or digestive sequelae; (2) the collection of data; and (3) the identification of psychological and/or social problems and provision of appropriate support to the patients. No randomized controlled trials on the role of follow-up after curative resection of gastric carcinoma have been published. Herein, the primary retrospective series and systematic reviews on this subject are analyzed and discussed. Furthermore, the guidelines from international and national scientific societies are discussed. Follow-up is recommended by the majority of institutions; however, there is no real evidence that follow-up can improve long-term survival rates. Several studies have demonstrated that it is possible to stratify patients submitted to curative gastrectomy into different classes according to the risk of recurrence. Furthermore, promising studies have identified several molecular markers that are related to the risk of relapse and to prognosis. Based on these premises, a promising strategy will be to tailor follow-up in relation to the patient and tumor characteristics, molecular marker status, and individual risk of recurrence.

Keywords: Gastric cancer; Follow-up; Surgery; Gastric carcinoma; Chemotherapy; Surveillance; Recurrence; Markers; Imaging

Core tip: There is still no consensus on the utility, frequency and regimen of follow-up after curative resection for gastric cancer. Surveillance programs may allow the following: (1) the early diagnosis of recurrence; (2) the detection of adverse effects of a previous surgery; (3) the collection of data; and (4) the detection of psychological and social problems. This editorial discusses the main studies, systematic reviews and guidelines on this subject. Several studies have demonstrated that patients may be stratified according to the risk of recurrence. A promising strategy will be to tailor follow-up in relation to the patient and tumor characteristics, molecular marker status, and individual risk of recurrence.