Follow-up after gastrectomy for cancer: the Charter Scaligero Consensus Conference

Abstract

Purpose Presently, there is no scientific evidence supporting a definite role for follow-up after gastrectomy for cancer, and clinical practices are quite different around the globe. The aim of this consensus conference was to present an ideal prototype of follow-up after gastrectomy for cancer, based on shared experiences and taking into account the need to rationalize the diagnostic course without losing

Postoperative follow-up programs improve survival in curatively resected gastric and junctional cancer patients: a propensity score matched analysis

“…In the absence of randomized controlled trials, the discussion on the need, schedule, and recommended examinations for follow-up after resection of esophagogastric cancer has been completely controversial worldwide [12][13][14][15]24].…”

“…The need for more than symptom-driven surveillance is also reflected by the Charter Scaligero on follow-up after gastrectomy for cancer, which was developed by a panel of experts during the 10th International Gastric Cancer Congress in Verona. The Charter states that follow-up should be adapted to the stage of disease, should consist of clinical review and cross-sectional imaging with or without upper gastrointestinal endoscopy, and should be discontinued after 5 years [24].…”

“…Besides the key question whether an intensive follow-up is generally beneficial, at least for a subgroup of patients, it is even more controversial which diagnostic means should be employed during postoperative surveillance and in which intervals [23,40,41,[46][47][48][49]. Most studies report the highest probability of recurrence during the first 2 years after surgery, whereas relapse after more than 5 years in gastric cancer is reported to be extremely rare [3,24,42,50,51].…”

The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015

“…However, routine follow-up should be offered to all patients for the following reasons: oncological (detection and management of cancer recurrence), gastroenterological (endoscopic surveillance and management of postgastrectomy symptoms), research (collection of data on treatment toxicity, time to and site of recurrence, survival, and costbenefit analyses), and pastoral (psychological and emotional support) [41,42]. Follow-up should include lifetime monitoring of the nutritional sequelae of gastrectomy, including, but not limited to, adequate vitamin B 12 , iron, and calcium replacement.…”

Early detection of nonperitoneal recurrence may contribute to survival benefit after curative gastrectomy for gastric cancer

“…The European Society of Medical Oncology recommends evaluation by patient-led self-referral without regular examination [4]. On the other hand, International Gastric Cancer Association statements have recommended routine follow-up after curative gastrectomy from oncological, gastroenterological, research, and pastoral aspects, despite a lack of evidence supporting prolonged survival [5]. Japanese treatment guidelines for gastric cancer also recommend routine follow-up after curative gastrectomy [6].…”