Extended follow-up after gastrectomy in elderly patients: Improved postrecurrence survival but no overall survival benefit in patients aged 73 years or older

Abstract

Background Our previous cohort study suggested potential survival benefits of extended follow-up beyond 5 years in survivors of gastric cancer. However, its clinical value in elderly patients with varying health status and life expectancy remains unclear. Methods Overall, 21,902 patients with gastric cancer aged >= 65 years without recurrence or other cancers within 5 years postgastrectomy were extracted from the Korean National Health Insurance claims database. Overall survival was compared between regular and irregular follow-up groups to determine a cut-off age beyond which no additional survival benefit was observed. In patients above this age with late recurrence or gastric remnant cancer, the impact of follow-up on postrecurrence survival was assessed. Results The survival benefit of extended regular follow-up was limited to patients aged 65-72 years and was not observed in those aged >= 73 years, which was defined as the cut-off. Among the 12,295 patients aged >= 73 years who remained disease-free for 5 years after gastrectomy, 922 (7.5%) developed late recurrence or gastric remnant cancer. In this group, extended regular follow-up was significantly associated with improved postrecurrence survival (5-year survival: 51.8% vs 24.3%, P < .001). In addition, follow-up intervals longer than 2 years for either endoscopy or computed tomography were associated with poorer survival outcomes. Conclusion Extended follow-up improved postrecurrence survival but not overall survival in patients aged >= 73 years. These findings suggest that follow-up strategies for this population may need to be individualized, considering overall health status and potential benefit.