Preoperative staging and postoperative surveillance for gastric cancer

Physicians must consider multiple factors when determining the most appropriate preoperative imaging strategy for gastric cancer. Health care resources are not unlimited, and the use of multiple expensive imaging techniques that do not alter treatment decisions is not recommended. With this in mind, EGD and CT scan alone should form the basis for preoperative evaluation, with further imaging considered only in selected cases. Based on the reviewed literature, we do not recommend routine surveillance imaging after curative surgery for gastric cancer. We agree with current NCCN guidelines that recommend history and physical examination every 4 to 6 months for 3 years, followed by yearly examinations. Imaging studies and endoscopy should be selectively performed in symptomatic patients.