Impact of the Surveillance Interval on the Survival of Patients Who Undergo Curative Surgery for Gastric Cancer

Abstract

Background For patients who undergo gastrectomy for gastric cancer, systematic follow-up evaluation to detect recurrent lesions is recommended, although the benefits of a surveillance program using short-term imaging studies have not been evaluated.

Methods This study reviewed the clinical data of patients who underwent curative surgery for gastric cancer using a prospective database. Patients with recurrence were classified according to surveillance interval as follows: ≤3, 3–6, and 6–12 months.

Results Of the 2785 patients who underwent curative surgery for gastric cancer, 376 (13.5 %) had intraabdominal recurrences, excluding the stomach. Multivariable analysis showed that a short surveillance interval did not increase the post-recurrence survival duration (with 6–12 months as the reference: ≤3 months: hazard ratio [HR] 0.954; 95 % confidence interval [CI] 0.689–1.323; 3–6 months: HR 0.994, 95 % CI 0.743–1.330). In addition, short surveillance intervals did not increase overall survival (with 6–12 months as the reference: ≤3 months: HR 0.969; 95 % CI 0.699–1.342; 3–6 months: HR 0.955; 95 % CI 0.711–1.285). In contrast to the surveillance interval, age, cancer stage, symptoms at recurrence, and recurrence time after gastrectomy were factors associated with both post-recurrence survival and overall survival.

Conclusions Although the detection of recurrence before symptoms helped to prolong both post-recurrence survival and overall survival, shortening the surveillance interval to less than 6 months did not improve either the patient’s post-recurrence survival or overall survival. Hence, it is not recommended that asymptomatic patients undergo surveillance involving imaging studies more often than once a year.