Cost-benefit of follow-up after total gastrectomy

An appraisal in terms of cost/benefit or follow-up gastrectomy for gastric cancer is made. Between 1981 and 1987, 90 patients underwent surgery (resectability 94%); of the radically treated patients, 32 underwent total gastrectomy (55%) and 26 subtotal resection (44%). In the group of 32 patients receiving palliative treatment, 11 underwent total gastrectomy. Two patients (4.6% died postoperatively of pulmonary complications and hyperosmolar coma during TPN. Instrumental, clinical and laboratory follow-up was performed in 82 patients out of 88 (93%), 6 not being available for outpatient follow-up. Our standard follow-up examination in these patients includes the following studies (chest x-ray, EGD, liver ultrasound, upper abdominal CT scan, cholescintigraphy with HIDA and barium examination of the upper G.I., tract when needed) performed every 6 months for the first 2 years and then annually for the next 5 years. Laboratory tests were performed every 3 months for the first 2 years and then every 12 months in order to monitor both evolution of neoplasia and possible metabolic functional problems. In the group of patients who underwent total radical gastrectomy, no side-effects or dysfunctional problems were observed, and the recovery of body weight was never less than 80% of the weight prior to diagnosis of the disease. Until now, 4 deaths due to neoplasia have occurred, 2 of which following recurrences after total gastrectomy for peritoneal carcinosis and multiple liver metastases, with an average survival time of 21 months.(ABSTRACT TRUNCATED AT 250 WORDS)