[Evaluation and problems of follow-up surveillance after curative gastric cancer surgery]

Recurrence patterns after curative gastrectomy and follow-up surveillance were studied by referring to the literature. An analysis was done of 151 (11.5%) recurrent patients among 1,323 primary gastric cancer patients after curative (R0) resection. The recurrence rate was hematologic in 43%, peritoneal in 32.5%, and remote lymph node in 22.5%, although peritoneal recurrence was the most frequent in references. There were many peritoneal and remote lymph node recurrences in undifferentiated adenocarcinoma and hematologic recurrence in differentiated adenocarcinoma. In pT1, the hematologic recurrence rate was 90% and lymph node recurrence rate was 10%, which occurred even after 5 years. The frequency of peritoneal recurrence increased markedly in pT3. The rate of recurrence was 74.1% within 2 years and 88.1% within 3 years. There was no difference between lymph node, hematologic, and peritoneal recurrence in terms of survival time after surgery or even after recurrence. Referring to these results, follow-up surveillance programs for early and advanced gastric caner were developed. Surveillance will be continued for 10 years after surgery and mass survey or complete medical checkup is recommended 5 years after surgery. A standard follow-up program should exist, although it is not necessary for it to be the same in different institutes. There is as yet no consensus regarding intensive follow-up after curative gastrectomy because the evidence of efficacy is weak. In conclusion, a randomized, controlled trial of intensive follow-up is required to demonstrate the survival effect of surveillance.