Detection and prognosis of recurrent gastric cancer-is routine follow-up after gastrectomy worthwhile?

Background/Aims: Although routine follow-up after surgery for gastric cance r is recommended its value after gastrectomy has not been evaluated. Methodology: All patients who underwent gastrectomy for gastric cancer ente ring the routine follow-up program between January 1987 and August 1996 wer e identified. The patients studied were those with either histologically pr oven recurrence or those in whom recurrence was highly probable from clinic al course. Two groups were compared. The first group comprised the patients whose recurrence was detected by routine follow-up prior to the developmen t of clinical signs (asymptomatic group). The second group consisted of the patients who developed clinical symptoms due to a recurrence that was dete cted subsequently (symptomatic group). The main parameters were the time un til recurrence occurred, the pattern of recurrence, treatment and survival. Results: Out of 184 patients entering the routine follow-up 135 patients ha d undergone potentially curative gastrectomy. Sixty-seven patients (49.6%) had recurrences. Only 15 (22.3%) belonged to the asymptomatic group and 52 (77.7%) to the symptomatic one. The time until recurrence occurred was not different between the 2 groups (17.1 vs. 18.0 months). Chemotherapy was per formed more frequently in the asymptomatic group and survival was longer (8 .4 vs. 5.9 months). This difference was due to the time the patients remain ed asymptomatic (average 43 months). No effect of either early detection or chemotherapy was seen. In the asymptomatic group distant recurrence was co mmon while recurrence in the symptomatic group was more often local but thi s difference did not reach statistic significance. Conclusions: Routine follow-up after gastrectomy for gastric cancer does no t contribute to early detection of gastric cancer recurrence. It has no ben efit with respect to treatment and survival of patients with recurrent dise ase and should therefore be reduced to symptomatic and psychological afterc are.